Individual
DR. BRIAN T. BAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, MD
Contact information
Practice address
513 PARNASSUS AVE RM S738, SAN FRANCISCO, CA 94143-2205
(415) 476-3242
(415) 476-0665
Mailing address
1635 DIVISADERO ST, SUITE 625, BOX 1821, SAN FRANCISCO, CA 94143-0001
(415) 476-4029
(415) 476-4150
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
A77023
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A770230
—
CA
Enumeration date
07/18/2006
Last updated
07/09/2007
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