| NPI | 1679618326 |
|---|---|
| Doing Business As | PRIOR LAKE ORTHODONTICS |
| Entity Type | Organization |
| Authorized Contact | JOSEPH SAMUEL BASILE Orthodontist 952-454-5345 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN MN10983) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2009-02-17 |