DR. BRUCE JAMES MATHIASON (NPI# 1366405722) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366405722 |
| Entity Type | Individual |
| Full Name | DR. BRUCE JAMES MATHIASON |
| Credential | DDS |
| Practice Address |
400 7th St Walnut Grove MN 56180-9203 |
| Practice Telephone | 5078592179 |
| Practice Fax Number | 5078592178 |
| Mailing Telephone | 5078592179 |
| Mailing Fax Number | 5078592178 |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
D8569 | MN | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | MEDICALASSISTANCE | 2420L8000 | 01 |
| Street Address |
400 7TH ST |
| City | WALNUT GROVE |
| State | MN |
| Zip Code | 56180-9203 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073675716 | City of Walnut Grove | Ambulance | 311 6th St, Walnut Grove, MN 56180-1107 | 2006-12-15 |
| 1033306931 | Sanford Health Network | Clinic/Center | 830 8th St, Walnut Grove, MN 56180-1117 | 2007-09-25 |
| 1033176854 | City of Walnut Grove | Assisted Living Facility | 810 8th St, Walnut Grove, MN 56180-1147 | 2006-04-26 |
| 1184929952 | Lois E Boerboom | Registered Nurse | 15402 140th St, Walnut Grove, MN 56180-5311 | 2011-01-25 |
| 1750993317 | Jill Marie Stoks | Registered Nurse | 13526 Camp Ave, Walnut Grove, MN 56180-5343 | 2020-08-17 |
| 1811596984 | Proconcierge Nursing Service, LLC | Nursing Care | 13526 Camp Ave, Walnut Grove, MN 56180-5343 | 2020-10-20 |
| 1124269808 | Minnesota Senior Care, Inc. | Preferred Provider Organization | 361 8th St Apt 102, Walnut Grove, MN 56180-9372 | 2009-03-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750993317 | Jill Marie Stoks | Registered Nurse | 13526 Camp Ave, Walnut Grove, MN 56180-5343 | 2020-08-17 |
| 1376188086 | Marshall Devolopmental Therapy Services Inc | Behavioral Analyst | 308 Estes Mill Rd, Walnut Grove, MS 39189-5043 | 2019-11-18 |
| 1164073714 | Amanda Sue Allen | Technician | 5530 S 47th Rd, Walnut Grove, MO 65770-7503 | 2019-09-25 |
| 1700437308 | Walnut Grove School Dist R5 | Local Education Agency (LEA) | 300 W College St, Walnut Grove, MO 65770-8304 | 2019-09-25 |
| 1144745589 | Diane Teresa Thomas | Registered Nurse | 13927 Main St., Walnut Grove, CA 95690 | 2017-08-07 |
| 1295259521 | Stephanie Joy Salinas Cachero | Behavior Technician | 1304 Mealer Lane, Walnut Grove, CA 95690 | 2017-07-28 |
| 1578009155 | First-line LLC | Ambulance | 2354 Union Rd, Walnut Grove, MS 39189-5189 | 2017-01-06 |
| 1184929952 | Lois E Boerboom | Registered Nurse | 15402 140th St, Walnut Grove, MN 56180-5311 | 2011-01-25 |
| 1124269808 | Minnesota Senior Care, Inc. | Preferred Provider Organization | 361 8th St Apt 102, Walnut Grove, MN 56180-9372 | 2009-03-10 |
| 1497901797 | Steven Richard Caplan | Psychologist | 14286 State Hwy160 #282, Walnut Grove, CA 95690-0282 | 2008-08-18 |
| Find all providers in WALNUT GROVE | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962001149 | Kalyan Chakravarthy Kondreddi | Dentist | 327 Western Ave Ste A, Fergus Falls, MN 56537-2403 | 2020-10-20 |
| 1821696022 | Wyoming Family Dental | Dentist | 5378 East Viking Blvd., Wyoming, MN 55092 | 2020-10-12 |
| 1770190951 | Bluff Creek Dental Pllc | Dentist | 600 Market St Ste 130, Chanhassen, MN 55317-4570 | 2020-09-30 |
| 1205443850 | Birchwood Dental, LLC | Dentist | 3356 Sherman Crt Ste 101, Eagan, MN 55121 | 2020-09-28 |
| 1073128153 | Michael W Flinn Dds, Pa | Dentist | 200 Firewood Drive, Redwood, MN 56283 | 2020-09-15 |
| 1770196891 | Thomas J Hoeffel Dds Pa | Dentist | 2819 Hamline Ave N Ste 104, Roseville, MN 55113-7718 | 2020-08-28 |
| 1073123030 | True North Community Dental Clinic, LLC | Dentist | 415 East First Avenue, Shakopee, MN 55379 | 2020-08-05 |
| 1679182687 | Downtown Dental Center Pllc | Dentist | 825 Nicollet Mall Ste 1427, Minneapolis, MN 55402-2703 | 2020-07-26 |
| 1205444791 | Patrick Reilly Steck | Dentist | 4948 S 34th Ave, Minneapolis, MN 55417 | 2020-07-21 |
| 1386252344 | Kacie Crowell Green | Dentist | 8900 Walnut St # 459, Rockford, MN 55373-5135 | 2020-07-16 |
| Find all providers with the same taxonomy | ||||
| City | WALNUT GROVE |
| Zip Code | 56180 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.