Active NPI
Bruce Dordick, D.D.S.
- Periodontics
- Philadelphia, PA
National Provider Identifier
1134562788
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- DS017728L
- Practice address
- 1601 Walnut St
Suite 201
Philadelphia, PA 19102-2944 - Phone
- (215) 545-1677
- NPI assigned
- Apr 14, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | DS017728L | PA | Primary |
Addresses
Primary practice location
1601 Walnut St
Suite 201
Philadelphia, PA 19102-2944
Mailing address
1601 Walnut St
Suite 201
Philadelphia, PA 19102-2944
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS017728L | PA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1365897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365897600000",
"number": "1134562788",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1601 WALNUT ST",
"address_2": "SUITE 201",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191022944"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1601 WALNUT ST",
"address_2": "SUITE 201",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191022944",
"telephone_number": "215-545-1677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DORDICK",
"first_name": "BRUCE",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-04-14",
"last_updated": "2013-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "PA",
"license": "DS017728L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 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.