Provider Demographics
NPI:1447675863
Name:SEAN BASTANI D.D.S P.A
Entity type:Organization
Organization Name:SEAN BASTANI D.D.S P.A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BASTANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-866-0049
Mailing Address - Street 1:1125 CYPRESS STATION DR STE A-1
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3055
Mailing Address - Country:US
Mailing Address - Phone:281-866-0049
Mailing Address - Fax:
Practice Address - Street 1:1125 CYPRESS STATION DR STE A-1
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3055
Practice Address - Country:US
Practice Address - Phone:281-866-0049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX215952710Medicaid