Individual
DR. ISMAEL BASTIDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4014 82ND ST, ELMHURST, NY 11373-1305
(718) 397-7777
Mailing address
4014 82ND ST, ELMHURST, NY 11373-1305
(718) 397-7777
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
052687
NY
Other
Enumeration date
08/14/2006
Last updated
04/14/2015
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