Sanju Basi, DDS
Individual provider Active NPI Dentist · Rockland, ME
NPI 1477035905 · NPPES record last updated Aug 21, 2023
Key facts
- NPI
- 1477035905
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DEN5002 (ME)
- Practice address
- 19 Summer Street
Rockland, ME 04841-9800 - Phone
- (207) 594-8353
- NPI assigned
- Aug 31, 2018
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DEN.00203772 | CO | MD | Dentist |
| DEN5002 | ME | MD | Dentist |
| 016.0134141 | VT | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 016.0134141 | VT | |
| Dentist | 122300000X | DEN.00203772 | CO | |
| Dentist | 122300000X | DEN5002 | ME | Yes |
Addresses
Primary practice location
19 Summer Street
Rockland, ME 04841-9800
Mailing address
19 Summer St
Rockland, ME 04841-2917
Phone (207) 594-8353
Other providers in Rockland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 21, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.