David C Bastacky DMD PA

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

10337 Issued in MD

Legal business name

DAVID C BASTACKY DMD PA

Practice address

516 N Rolling Rd
Suite 104
Baltimore, MD 21228-4140

Phone

(410) 744-4222

Fax

(410) 744-2472

NPI assigned

Mar 20, 2007

Last updated

Apr 20, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. David Bastacky, DMD PANPI 1164429387

Title

Doctor Owner

Phone

(410) 744-4222

Specialties & licenses 1

Addresses

Other identifiers 11

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• David C Bastacky, DMD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Baltimore, MD
  • NPI 1164429387
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1245355312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 N ROLLING RD",
            "address_2": "SUITE 104",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212284140",
            "telephone_number": "410-744-4222",
            "fax_number": "410-744-2472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 N ROLLING RD",
            "address_2": "SUITE 104",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212284140",
            "telephone_number": "410-744-4222",
            "fax_number": "410-744-2472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID C BASTACKY DMD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "BASTACKY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "DOCTOR OWNER",
        "authorized_official_telephone_number": "410-744-4222",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD PA"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MD",
            "license": "10337",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHN",
            "identifier": "168250000",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST",
            "identifier": "N930 62930",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "42602402",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL BENEFIT PROVIDERS",
            "identifier": "93918-1",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FED MED",
            "identifier": "3822",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "795229",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA MEDICAL HMO",
            "identifier": "2038621",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA DENTAL",
            "identifier": "4141305",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL NETWORK",
            "identifier": "S164",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MDIPA",
            "identifier": "210589",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DHA FORTIS",
            "identifier": "2715",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Oral and Maxillofacial Surgery (Dentist) in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.