Charles William Bruchu, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D14692 Issued in MN

Practice address

1077 Helmo Ave N Ste 130
Oakdale, MN 55128-5710

Phone

(651) 238-6795

NPI assigned

Mar 28, 2018

Last updated

Mar 10, 2022By 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 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1522195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646870400000",
    "number": "1659876852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1077 HELMO AVE N STE 130",
            "city": "OAKDALE",
            "state": "MN",
            "postal_code": "551285710",
            "telephone_number": "651-238-6795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1077 HELMO AVE N STE 130",
            "city": "OAKDALE",
            "state": "MN",
            "postal_code": "551285710",
            "telephone_number": "651-238-6795"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "43000 Midway Ave",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921405692",
            "country_code": "US",
            "telephone_number": "619-524-4005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRUCHU",
        "first_name": "CHARLES",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-28",
        "last_updated": "2022-03-10",
        "certification_date": "2022-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "00203475",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "00203475",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D14692",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Christina Bretson, MSW, LICSW
• Margaret Hope Breuer
• Bristol Hospice - Minnesota LLC
• Latarsha Nicole Bronaugh, LPCC
• Amy Marie Brown, MA, LMFT
• Lauri Ann Brunello, MA, LPCC
• Delaney Lynn Budge
• Maria Ariella Burgesen, CNA, HHA
• Eileen Buringrud, M.A., LP
• Tara Burklund, LICSW

• General Practice Dentistry in Oakdale, MN
• Providers in Oakdale, 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 Mar 10, 2022; 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.