Organization
MNPL02 PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOLAS BUSSA DDS (MEMBER)
(218) 349-8564
Entity
Organization
Contact information
Practice address
1099 HELMO AVE N STE 110, OAKDALE, MN 55128-6034
(651) 372-3300
(651) 337-8305
Mailing address
14300 CLAY TERRACE BLVD STE 249, CARMEL, IN 46032-3636
(317) 502-0717
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
07/19/2023
Last updated
07/19/2023
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