Organization
BASILE ORTHODONTICS PA
Active
Parent organization
BASILE ORTHODONTICS, P.A.
Other names
Minnetonka Lake Orthodontics
Organization subpart
Yes
Provider details
NPI number
Legal business name
BASILE ORTHODONTICS, P.A.
Authorized official
DR. JOSEPH SAMUEL BASILE III D.D.S. (ORTHODONTIST)
(952) 474-3203
Entity
Organization
Contact information
Practice address
17809 HUTCHINS DRIVE, SUITE 101, MINNETONKA, MN 55345
(952) 474-3203
(952) 474-3204
Mailing address
17809 HUTCHINS DRIVE, SUITE 101, MINNETONKA, MN 55345
(952) 474-3203
(952) 474-3204
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D10983
MN
Other
Enumeration date
05/10/2007
Last updated
02/17/2009
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