Basic Information
Provider Information
NPI: 1528559515
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BASSI
FirstName: PRIYANKA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: RDH
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 320 MANDARIN CT
Address2:  
City: LIVINGSTON
State: CA
PostalCode: 953349586
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1140 MAIN ST
Address2:  
City: LIVINGSTON
State: CA
PostalCode: 953341257
CountryCode: US
TelephoneNumber: 2093947913
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/24/2018
LastUpdateDate: 05/24/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
124Q00000X25651CAY Dental ProvidersDental Hygienist 

No ID Information.


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