Gerard F Koorbusch, DDS, MBA

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

1818 Issued in ND

Practice address

1140 W Capitol Ave
Bismarck, ND 58501-9956

Phone

(701) 258-7220

Fax

(701) 222-2329

NPI assigned

Jun 14, 2006

Last updated

Dec 14, 2010By 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 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Business Administration

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292284800000",
    "number": "1003859224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1140 W CAPITOL AVE",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585019956",
            "telephone_number": "701-258-7220",
            "fax_number": "701-222-2329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 W CAPITOL AVE",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585019956",
            "telephone_number": "701-258-7220",
            "fax_number": "701-222-2329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOORBUSCH",
        "first_name": "GERARD",
        "middle_name": "F",
        "credential": "DDS, MBA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2010-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "ND",
            "license": "1818",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41121",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "1818",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sanya L Kom, LPN
• Godwin Nakpan Konde
• Sai Nikhil Konduru, MD
• Sa Kong
• Stacey Lee Konzak, PA C
• Matthew John Kopp, FNP-C
• Donald J Kosiak, MD
• Julie Kost
• Katelynn Marie Kostelecky-Belland, DPT
• Michael G. Kostelecky, O.D.

• Oral and Maxillofacial Surgery (Dentist) in Bismarck, ND
• Providers in Bismarck, ND by specialty
• Oral and Maxillofacial Surgery (Dentist) in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2010; 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.