Individual
DR. ROBERT JAMES BASTIC II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
335 E WISCONSIN AVE, APPLETON, WI 54911-4821
(920) 734-1803
Mailing address
3601 N MEADOWSWEET LN, APPLETON, WI 54911-8564
(920) 734-1803
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2373
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33395400
—
WI
Enumeration date
11/01/2006
Last updated
07/08/2007
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