Isabel Bastos, DMD
Individual provider Active NPI Dentist · Long Branch, NJ
NPI 1962788091 · NPPES record last updated Dec 13, 2018
Key facts
- NPI
- 1962788091
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 22DI02485500 (NJ)
- Practice address
- 335 Broadway
Long Branch, NJ 07740-6901 - Phone
- (732) 475-3800
- Fax
- (732) 483-6444
- NPI assigned
- Nov 3, 2011
- Sex
- Female
- 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 |
|---|---|---|---|
| 22DI02485500 | NJ | MD | Dentist |
| DI02485500 | NJ | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DI02485500 | NJ | |
| Dentist | 122300000X | 22DI02485500 | NJ | Yes |
Addresses
Primary practice location
335 Broadway
Long Branch, NJ 07740-6901
Mailing address
270 Broadway
Long Branch, NJ 07740
Phone (732) 391-2824
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0279463 | Medicaid | NJ |
Other providers in Long Branch, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 13, 2018. 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.