MEDICARE: DR. SAEDA BASTA DDS, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0700X	Prosthodontics	45261	CA

General Provider Information

NPI Number	:	1568486934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAEDA BASTA DDS, MS

Provider Business Mailing Address
First Line	:	217 W SAN BERNARDINO RD
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91723-1516
Country	:	US
Telephone Number	:	626-915-7711
Fax Number	:	626-915-7722

Provider Business Practice Location Address
First Line	:	217 W SAN BERNARDINO RD
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91723-1516
Country	:	US
Telephone Number	:	626-915-7711
Fax Number	:	626-915-7722

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	02/16/2009

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