Bryan Jeffrey Ophaug, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11890 Issued in MN

Practice address

7123 Bass Lake Rd
New Hope, MN 55428-3822

Phone

(763) 533-5359

Fax

(763) 533-0010

NPI assigned

Feb 8, 2007

Last updated

Jul 8, 2007By 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

State licenses

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.

• Bryan J. Ophaug, D.D.S., P.a.

  • General Practice Dentistry
  • New Hope, MN
  • NPI 1639334428
  NPD (past) Authorized official
• Robert D Thompson DDS PA

  dba Bass Lake Dental Group

  • General Practice Dentistry
  • New Hope, MN
  • NPI 1972699908
  NPD (past)

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1558401240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5033 XERXES AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554102227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7123 BASS LAKE RD",
            "city": "NEW HOPE",
            "state": "MN",
            "postal_code": "554283822",
            "telephone_number": "763-533-5359",
            "fax_number": "763-533-0010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OPHAUG",
        "first_name": "BRYAN",
        "middle_name": "JEFFREY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D11890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin Oberreuter, B.A.
• Olea Therapy (Olea Pediatric Therapy)
• Leslie Ann Olson
• Mitchell C Olson, DC
• Open Mind Center LLC
• Own Self Be True, LLC (Be True)
• Papacare, Inc.
• Peter Jay Paulson, D.D.S.
• Jacob Paust
• Michelle Pelzel

• General Practice Dentistry in New Hope, MN
• Providers in New Hope, 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 8, 2007; 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.