| NPI | 1194939041 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH SAMUEL BASILE Orthodontist 952-474-3203 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: MN D10983) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2009-02-17 |