Kurt Bruksch, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

3721 Issued in WI

Practice address

690 North Route #31
Crystal Lake, IL 60012

Phone

(815) 459-5600

Fax

(815) 459-5601

NPI assigned

Aug 3, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective May 24, 2022 through May 24, 2028

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277251200000",
    "number": "1154339448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "690 NORTH ROUTE #31",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "60012",
            "telephone_number": "815-459-5600",
            "fax_number": "815-459-5601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "690 NORTH ROUTE #31",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "60012",
            "telephone_number": "815-459-5600",
            "fax_number": "815-459-5601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUKSCH",
        "first_name": "KURT",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-03",
        "last_updated": "2010-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "019018137",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WI",
            "license": "3721",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina Brown
• Clara Louise Brown, LCSW
• Kevin M Bruggeman, DDS
• Paul A Bruggeman, DDS
• Sara Renee Brugioni, LCSW
• Venkata L.N.V.K Buddharaju, M.D
• Joseph Budreck, PTA
• Stephanie Budron, LPC
• Nicole Ashley Buedel
• Adam Buffington, DPM

• Oral and Maxillofacial Surgery (Dentist) in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.