| Dr Damaris Bastian Gen.dent. Llc | |
|
101 Devant St Ste 404 Fayetteville GA 30214-2713 | |
| (678) 884-5352 | |
| Not Available |
| Full Name | Dr Damaris Bastian Gen.dent. Llc |
|---|---|
| Speciality | Dentist |
| Location | 101 Devant St Ste 404, Fayetteville, Georgia |
| Authorized Official Name and Position | Damaris Derece Bastian (OWNER) |
| Authorized Official Contact | 6788845352 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Damaris Bastian Gen.dent. Llc 101 Devant St Ste 404 Fayetteville GA 30214-2713 Ph: (678) 884-5352 | Dr Damaris Bastian Gen.dent. Llc 101 Devant St Ste 404 Fayetteville GA 30214-2713 Ph: (678) 884-5352 |
| NPI Number | 1609089002 |
|---|---|
| Provider Enumeration Date | 05/08/2007 |
| Last Update Date | 11/08/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609089002 | NPI | - | NPPES |
| 1850870 | Medicaid | LA | |
| 4334104830 | Other | LA | BLUE CROSS BLUE SHEILD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 5087 (Louisiana) | Primary |
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