| NPI | 1639334428 |
|---|---|
| Other Name | BASS LAKE DENTAL GROUP |
| Entity Type | Organization |
| Authorized Contact | BRYAN JEFFREY OPHAUG President 763-533-5359 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D11890) |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2008-07-22 |