Nicholas Robert Bussa

Primary specialty

DentistTaxonomy code 122300000X

License

D13556 Issued in MN

Practice address

4600 Excelsior Blvd
St Louis Park, MN 55416-4938

Phone

(952) 926-3392

NPI assigned

Feb 17, 2015

Last updated

Oct 6, 2026By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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.

• Jain Dental St. Louis Park, PLLC

  • Dental Clinic/Center
  • St Louis Park, MN
  • NPI 1497373195
  NPD Authorized official
• Perfect Teeth - North Sheridan P.C.

  • General Practice Dentistry
  • Westminster, CO
  • NPI 1720109291
  NPD (past)

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

{
    "created_epoch": "1424131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791244800000",
    "number": "1679964357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 EXCELSIOR BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554164938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 EXCELSIOR BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554164938",
            "telephone_number": "952-926-3392"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "604 Bielenberg Dr Ste 230",
            "address_purpose": "LOCATION",
            "city": "Woodbury",
            "state": "MN",
            "postal_code": "551251733",
            "country_code": "US",
            "telephone_number": "612-279-5410",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUSSA",
        "first_name": "NICHOLAS",
        "middle_name": "ROBERT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-02-17",
        "last_updated": "2026-10-06",
        "certification_date": "2026-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D13556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Wright Bursack, M.A.L.P.
• Alex Andrew Burton, DPT
• Jason L Buseman
• Magda Bushara, M.D.
• Deborah Bushway, PH.D., LP
• Peter Donald Busselberg, M.D.
• Michael John Butcher, D.O.
• Jenna Lee Buth-Croes, PSYD
• Todd A Butler, CRNA, MS
• Susan Ashlie Doorenbos Butz

• Dentist in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2026; 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.