Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | D10756 | MN |
NPI | 1124219555 |
---|---|
Provider Name | Dr. Christopher Thomas Sasik |
First Address | Plymouth, MN 55447-1540 |
Second Address | Plymouth, MN 55447-1540 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2007 |
Last Update Date | 09/08/2007 |