Organization
BASILE ORTHODONTICS PA
Active
Parent organization
BASILE ORTHODONTICS PA
Other names
Prior Lake Orthodontics
Organization subpart
Yes
Provider details
NPI number
Legal business name
BASILE ORTHODONTICS PA
Authorized official
DR. JOSEPH SAMUEL BASILE III D.D.S. (ORTHODONTIST)
(952) 454-5345
Entity
Organization
Contact information
Practice address
5116 GATEWAY STREET SE #103, SUITE #103, PRIOR LAKE, MN 55372
(952) 447-6088
(952) 447-6099
Mailing address
5116 GATEWAY ST. S.E., SUITE 103, PRIOR LAKE, MN 55372
(952) 447-6088
(952) 447-6099
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
MN10983
MN
Other
Enumeration date
02/20/2007
Last updated
02/17/2009
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