MEDICARE: BASHAR ADEINAT

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223P0300X	Periodontics	DN22303	FL

General Provider Information

NPI Number	:	1902248412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BASHAR ADEINAT

Provider Business Mailing Address
First Line	:	3388 49TH ST N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33710-2146
Country	:	US
Telephone Number	:	860-218-5560
Fax Number	:

Provider Business Practice Location Address
First Line	:	3388 49TH ST N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33710-2146
Country	:	US
Telephone Number	:	860-218-5560
Fax Number	:

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

Provider Enumeration Date	:	07/25/2013
Last Update Date	:	02/01/2025

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Directions to “ BASHAR ADEINAT ” Practice Location

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