Individual provider Active NPI

Bruce J Martinson, DDS

  • General Practice Dentistry
  • Wayzata, MN
National Provider Identifier
1275527442
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D9301 Issued in MN
Practice address
317 Wayzata Blvd E
Wayzata, MN 55391-1683
Phone
(952) 473-4639
Fax
(952) 473-1788
NPI assigned
Sep 2, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D9301 MN Primary

Addresses

Primary practice location

317 Wayzata Blvd E
Wayzata, MN 55391-1683

Mailing address

317 Wayzata Blvd E
Wayzata, MN 55391-1683
Phone (952) 473-4639

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160128001799 MN Order and Referring Only - DentistPractitioner - Dentist 3779886569

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D9301MNMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1125619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1275527442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "317 WAYZATA BLVD E",
            "city": "WAYZATA",
            "state": "MN",
            "postal_code": "553911683",
            "telephone_number": "952-473-4639",
            "fax_number": "952-473-1788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "317 WAYZATA BLVD E",
            "city": "WAYZATA",
            "state": "MN",
            "postal_code": "553911683",
            "telephone_number": "952-473-4639",
            "fax_number": "952-473-1788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINSON",
        "first_name": "BRUCE",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-02",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D9301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wayzata, MN

Sources for this page

Verify at the official NPI Registry.