Individual
ANDREW W BASTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DENTIST
Contact information
Practice address
130 MYRTLE AVE, UNIT G, STAMFORD, CT 06902-3932
(973) 632-7971
Mailing address
130 MYRTLE AVE, UNIT G, STAMFORD, CT 06902-3932
(973) 632-7971
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
009302
CT
122300000X
Dentist
0511631
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
009302
STATE LICENSE
CT
Enumeration date
10/20/2005
Last updated
03/16/2008
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