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Individual
NINOUSHA BASTI
Active
Individual
NINOUSHA BASTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
55294
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55294
DENTAL LICENSE
CA
Enumeration date
03/05/2007
Last updated
08/10/2015
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