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General NPI Number Information
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NPI Number | 1477035905
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Entity Type | Individual
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Provider Name | SANJU BASI DDS
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Gender | Male
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Dates
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Enumeration Date | 08/31/2018
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 19 SUMMER STREET
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City | ROCKLAND
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State | ME
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Zip | 04841-9800
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Country | US
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Telephone | 207-594-8353
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Fax |
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Provider Business Mailing Address
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Address Line | 19 SUMMER ST
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City | ROCKLAND
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State | ME
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Zip | 04841-2917
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Country | US
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Telephone | 207-594-8353
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 016.0134141
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN.00203772
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN5002
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License Number State | ME
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