| NPI | 1972699908 |
|---|---|
| Doing Business As | BASS LAKE DENTAL GROUP |
| Entity Type | Organization |
| Authorized Contact | ROBERT DUANE THOMPSON Owner 763-533-5359 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D7363) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2008-07-01 |