| NPI | 1750501136 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOANN MAROLD BASSING Direct Owner 218-741-0203 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D8895) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D8639) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2008-05-01 |