NPIMap

Organization Active NPI

Bruce F Andrekus, DDS,SC

  • Public Health Dentistry
  • Kenosha, WI
National Provider Identifier
1104942432
Registry record updated Jun 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health DentistryTaxonomy code 1223D0001X
License
3650 Issued in WI
Legal business name
BRUCE F ANDREKUS, DDS,SC
Practice address
3726 Roosevelt Rd
Kenosha, WI 53142-1900
Phone
(262) 652-7956
NPI assigned
Mar 21, 2007
Last updated
Jun 11, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Bruce Andrekus, DDSNPI 1497195127
Title
President
Phone
(262) 652-7956

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223D0001X 3650 WI Primary

Addresses

Primary practice location

3726 Roosevelt Rd
Kenosha, WI 53142-1900

Mailing address

3726 Roosevelt Rd
Kenosha, WI 53142-1900

National Provider Directory

National Provider Directory

Locations

3726 Roosevelt Rd
Kenosha, WI 53142
Phone (262) 652-7956

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370908800000",
    "number": "1104942432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3726 ROOSEVELT RD",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531421900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3726 ROOSEVELT RD",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531421900",
            "telephone_number": "262-652-7956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRUCE F ANDREKUS, DDS,SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2013-06-11",
        "status": "A",
        "authorized_official_last_name": "ANDREKUS",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-652-7956",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Dental Public Health",
            "state": "WI",
            "license": "3650",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenosha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2013; 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.