Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 18192 | OH |
NPI | 1053432849 |
---|---|
Provider Name | Dr. Anthony P Bastulli |
First Address | Mayfield Hts, OH 44124-2270 |
Second Address | Mayfield Hts, OH 44124-2270 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 08/07/2007 |