Individual
SANDY TAMER BASTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1257 BROAD ST, SUMTER, SC 29150-1973
(803) 773-1355
Mailing address
40 TRAVIS CT, SUMTER, SC 29154-4677
(201) 554-7385
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10569
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/12/2023
Last updated
08/09/2023
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