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General NPI Number Information
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NPI Number | 1962753996
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Entity Type | Individual
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Provider Name | TREVOR BASTA D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/01/2012
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Last Update Date | 10/01/2012
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Provider Practice Location Address
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Address Line | 840 I ST STE 3
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City | SPARKS
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State | NV
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Zip | 89431-3677
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Country | US
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Telephone | 775-358-1870
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Fax |
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Provider Business Mailing Address
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Address Line | 4575 CANYON DR
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City | RENO
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State | NV
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Zip | 89519-7900
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Country | US
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Telephone | 775-250-3499
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6336
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License Number State | NV
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