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Individual
KELLY CATHERINE BAST
Active
Individual
KELLY CATHERINE BAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
1188
AK
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
1188
AK
1223X2210X
Orofacial Pain Dentistry
1188
AK
Other
Enumeration date
11/30/2006
Last updated
09/06/2023
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