Bruce James Mathiason, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D8569 Issued in MN

Practice address

400 7TH St
Walnut Grove, MN 56180-9203

Phone

(507) 859-2179

Fax

(507) 859-2178

NPI assigned

Apr 7, 2006

Last updated

Jul 13, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1144368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1366405722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 7TH ST",
            "city": "WALNUT GROVE",
            "state": "MN",
            "postal_code": "561809203",
            "telephone_number": "507-859-2179",
            "fax_number": "507-859-2178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 7TH ST",
            "city": "WALNUT GROVE",
            "state": "MN",
            "postal_code": "561809203",
            "telephone_number": "507-859-2179",
            "fax_number": "507-859-2178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHIASON",
        "first_name": "BRUCE",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-07",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D8569",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICALASSISTANCE",
            "identifier": "2420L8000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lois E Boerboom, RN
• City of Walnut Grove (Country View)
• City of Walnut Grove
• Minnesota Senior Care, Inc.
• Proconcierge Nursing Service, LLC
• Sanford Health Network (Sanford Clinic Walnut Grove)
• Jill Marie Stoks, PHMNP
• True North Psychiatry, PLLC

• General Practice Dentistry in Walnut Grove, MN
• Providers in Walnut Grove, 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 Jul 13, 2026; 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.