Bruce A Mrusek, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

15490 Issued in OH

Practice address

5258 Montgomery Road
Norwood, OH 45212

Phone

(513) 531-2338

Fax

(513) 841-5545

NPI assigned

Nov 1, 2006

Last updated

Nov 19, 2015By 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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• The Wallace Group General Dentistry for Today, Inc

  • Dentist
  • Norwood, OH
  • NPI 1285004077
  NPD (past)
• Wallace Family Dentistry LLC

  • General Practice Dentistry
  • Cincinnati, OH
  • NPI 1649132192
  NPD (past)

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447891200000",
    "number": "1003993510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5258 MONTGOMERY ROAD",
            "city": "NORWOOD",
            "state": "OH",
            "postal_code": "45212",
            "telephone_number": "513-531-2338",
            "fax_number": "513-841-5545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5258 MONTGOMERY ROAD",
            "city": "NORWOOD",
            "state": "OH",
            "postal_code": "45212",
            "telephone_number": "513-531-2338",
            "fax_number": "513-841-5545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MRUSEK",
        "first_name": "BRUCE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2015-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "15490",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0685067",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARESOURCE- MANAGED CARE",
            "identifier": "311812190027",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Owen Edward Melton, CHT,CHBT,CHWS
• Joann Mikery-Munoz
• Virginia Ann Mindrum, RN
• Bakhtiar K Mohamad Amin, MD
• Ryan Morris
• Pamela Mullen, RN, MSN, CNS
• Elizabeth Nickell, PHARMD
• Norwood City Board of Health
• Norwood City Schools
• Norwood Endoscopy Center, LLC

• General Practice Dentistry in Norwood, OH
• Providers in Norwood, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2015; 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.