Bassilleann P.a.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

11975 Issued in MN

Legal business name

BASSILLEANN P.A.

Practice address

505 N. Walnut Street
Clearwater, MN 55320

Phone

(320) 558-6810

Fax

(320) 558-6006

NPI assigned

Dec 5, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Anne Marie Meyer

Title

Administration

Phone

(320) 558-6810

Specialties & licenses 1

Addresses

Other names 1

• Clearwater Family and Sedation Dentistry Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196812800000",
    "number": "1962684696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 187",
            "city": "CLEARWATER",
            "state": "MN",
            "postal_code": "553200187",
            "telephone_number": "320-558-6810",
            "fax_number": "320-558-6006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 N. WALNUT STREET",
            "city": "CLEARWATER",
            "state": "MN",
            "postal_code": "55320",
            "telephone_number": "320-558-6810",
            "fax_number": "320-558-6006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BASSILLEANN P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-05",
        "last_updated": "2007-12-05",
        "status": "A",
        "authorized_official_last_name": "MEYER",
        "authorized_official_first_name": "ANNE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "ADMINISTRATION",
        "authorized_official_telephone_number": "320-558-6810",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "11975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clearwater Family and Sedation Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Deborah Jill Allar
• Angelica Anderson, MS, RDN, LD
• John Vincent Austin, PH.D.
• Eron Lee Bordson, DC
• Deonna Lea Bouska, CMT
• Brooke Nicole Brower
• Centracare Clinic
• Clearwater Family Chiropractic Clinic

• General Practice Dentistry in Clearwater, MN
• Providers in Clearwater, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.