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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