Provider Demographics
NPI:1649484502
Name:BASILE, JOSEPH SAMUEL III (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:SAMUEL
Last Name:BASILE
Suffix:III
Gender:M
Credentials:DDS
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Mailing Address - Street 1:17809 HUTCHINS DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345
Mailing Address - Country:US
Mailing Address - Phone:952-474-3203
Mailing Address - Fax:952-474-3204
Practice Address - Street 1:17809 HUTCHINS DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345
Practice Address - Country:US
Practice Address - Phone:952-474-3203
Practice Address - Fax:952-474-3204
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MND109831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics