Organization
DAVID C BASTACKY DMD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID BASTACKY DMD PA (DOCTOR OWNER)
(410) 744-4222
Entity
Organization
Contact information
Practice address
516 N ROLLING RD, SUITE 104, BALTIMORE, MD 21228-4140
(410) 744-4222
(410) 744-2472
Mailing address
516 N ROLLING RD, SUITE 104, BALTIMORE, MD 21228-4140
(410) 744-4222
(410) 744-2472
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
10337
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
168250000
PHN
MD
01
—
2038621
AETNA MEDICAL HMO
MD
01
—
210589
MDIPA
MD
01
—
2715
DHA FORTIS
MD
01
—
3822
FED MED
MD
01
—
4141305
AETNA DENTAL
MD
01
—
42602402
BLUE CROSS
MD
01
—
795229
UNITED CONCORDIA
MD
01
—
93918-1
DENTAL BENEFIT PROVIDERS
MD
01
—
N930 62930
CAREFIRST
MD
01
—
S164
DENTAL NETWORK
MD
Enumeration date
03/20/2007
Last updated
04/20/2008
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