Provider Demographics
NPI:1518402395
Name:I-IMPLANT DENTISTRY
Entity Type:Organization
Organization Name:I-IMPLANT DENTISTRY
Other - Org Name:I-IMPLANT DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:S
Authorized Official - Middle Name:
Authorized Official - Last Name:BASSAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-331-3000
Mailing Address - Street 1:1101 2ND ST S
Mailing Address - Street 2:STE 209
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-2133
Mailing Address - Country:US
Mailing Address - Phone:320-331-3000
Mailing Address - Fax:320-257-5859
Practice Address - Street 1:1101 2ND ST S
Practice Address - Street 2:STE 209
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2133
Practice Address - Country:US
Practice Address - Phone:320-331-3000
Practice Address - Fax:320-257-5859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty