Robert Anthony Bottner, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0426301 Issued in NY

Practice address

375 Main St
Islip, NY 11751-3521

Phone

(631) 581-2038

Fax

(631) 224-1322

NPI assigned

Apr 13, 2007

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

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104040682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 MAIN ST",
            "city": "ISLIP",
            "state": "NY",
            "postal_code": "117513521",
            "telephone_number": "631-581-2038",
            "fax_number": "631-224-1322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 MAIN ST",
            "city": "ISLIP",
            "state": "NY",
            "postal_code": "117513521",
            "telephone_number": "631-581-2038",
            "fax_number": "631-224-1322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOTTNER",
        "first_name": "ROBERT",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "0426301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chelsea Rae Bjornsson, LPMHC
• Delores Bocklet, LCSW-R, CASAC
• Marisa Bonventre, OTR
• Georgiana Borda
• Tracey Maria Boriel, BA
• Christina Bozza, LMSW
• Jaclynn Brandi, LMT
• Kevin Brandt, MS, ATC, PES
• Karlene Elizabeth Braun-Oscher, P.T.
• Bridget Mary Breen, LMHC

• All providers in Islip, NY
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.