Provider Demographics
NPI:1104898626
Name:BASI, DAVID L (DMD PHD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:BASI
Suffix:
Gender:M
Credentials:DMD PHD
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Mailing Address - Street 1:2854 HIGHWAY 55
Mailing Address - Street 2:SUITE 130
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121
Mailing Address - Country:US
Mailing Address - Phone:651-842-3344
Mailing Address - Fax:651-842-3391
Practice Address - Street 1:515 DELAWARE ST SE
Practice Address - Street 2:7-174 MOOS TOWER
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-624-4435
Practice Address - Fax:612-624-2669
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MND11692204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U92959Medicare UPIN