Individual
ADAM DE LA BASTIDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
200 OLD COUNTRY RD, MINEOLA, NY 11501-4235
(516) 663-2752
Mailing address
2 DURHAM DR, DIX HILLS, NY 11746-5311
(631) 560-7811
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/22/2024
Last updated
05/22/2024
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