Individual
DR. BRUCE JAMES MATHIASON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
400 7TH ST, WALNUT GROVE, MN 56180-9203
(507) 859-2179
(507) 859-2178
Mailing address
400 7TH ST, WALNUT GROVE, MN 56180-9203
(507) 859-2179
(507) 859-2178
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D8569
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2420L8000
MEDICALASSISTANCE
MN
Enumeration date
04/07/2006
Last updated
07/08/2007
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