Provider Demographics
NPI:1528066370
Name:BASSETT CREEK DENTAL
Entity type:Organization
Organization Name:BASSETT CREEK DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:TSUCHIYA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-546-1301
Mailing Address - Street 1:5851 DULUTH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-3946
Mailing Address - Country:US
Mailing Address - Phone:763-546-1301
Mailing Address - Fax:763-546-0905
Practice Address - Street 1:5851 DULUTH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-3946
Practice Address - Country:US
Practice Address - Phone:763-546-1301
Practice Address - Fax:763-546-0905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty