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Organization
BRYAN J. OPHAUG, D.D.S., P.A.
Active
Organization
BRYAN J. OPHAUG, D.D.S., P.A.
Active
Other names
Bass Lake Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYAN JEFFREY OPHAUG D.D.S. (PRESIDENT)
(763) 533-5359
Entity
Organization
Contact information
Practice address
7123 BASS LAKE RD, NEW HOPE, MN 55428-3822
(763) 533-5359
(763) 533-0010
Mailing address
7123 BASS LAKE RD, NEW HOPE, MN 55428-3822
(763) 533-5359
(763) 533-0010
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D11890
MN
Other
Enumeration date
07/22/2008
Last updated
07/22/2008
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