Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 045376 | NY |
NPI | 1063543650 |
---|---|
Provider Name | William G Bast |
First Address | Sayville, NY 11782-3242 |
Second Address | Sayville, NY 11782-3242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 08/07/2007 |