Individual
TINA BASTAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
19963 VENTURA BLVD, WOODLAND HILLS, CA 91364-2631
(818) 703-0234
Mailing address
6148 CORAL PINK CIR, WOODLAND HILLS, CA 91367-7208
(949) 466-8550
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
103889
CA
Other
Enumeration date
04/19/2019
Last updated
08/30/2021
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