Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 24833 | FL |
N | 122300000X | Dentist | 7192 | NV |
NPI | 1003475161 |
---|---|
Provider Name | Caroline Basta |
First Address | Las Vegas, NV 89183-3978 |
Second Address | Orlando, FL 32806-6969 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2019 |
Last Update Date | 12/05/2020 |