Nicholas Philip Brong, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D13138 Issued in MN

Practice address

800 Marie Ave
South Saint Paul, MN 55075-2055

Phone

(651) 451-1277

NPI assigned

Jul 10, 2012

Last updated

Jul 10, 2012By 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

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dental South PA

  • Dentist
  • South St Paul, MN
  • NPI 1558431890
  NPD (past)

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

{
    "created_epoch": "1341878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1341878400000",
    "number": "1437414034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 MARIE AVE",
            "city": "SOUTH SAINT PAUL",
            "state": "MN",
            "postal_code": "550752055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 MARIE AVE",
            "city": "SOUTH SAINT PAUL",
            "state": "MN",
            "postal_code": "550752055",
            "telephone_number": "651-451-1277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRONG",
        "first_name": "NICHOLAS",
        "middle_name": "PHILIP",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-10",
        "last_updated": "2012-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D13138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ekraam Bedee Abdilahi
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• Hikmat Magassa Ayana
• Marcia Ann Bennett, PH.D., LP
• Bright Future Stars
• Carley Counseling, LLC
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• Derrick Connor
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• David L. Frisby, PTA

• General Practice Dentistry in South Saint Paul, MN
• Providers in South Saint Paul, 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 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.