Active NPI
Bruce D Rickoff, DDS
- Endodontics
- Duluth, GA
National Provider Identifier
1194909820
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- DN009884
- Practice address
- 9590 Medlock Bridge Rd
Suite G
Duluth, GA 30097-4443 - Phone
- (770) 232-5112
- Fax
- (770) 232-5115
- NPI assigned
- Dec 17, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | DN009884 | GA | Primary |
Addresses
Primary practice location
9590 Medlock Bridge Rd
Suite G
Duluth, GA 30097-4443
Mailing address
9590 Medlock Bridge Rd
Suite G
Duluth, GA 30097-4443
Phone (770) 232-5112
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150721002334 | GA | Order and Referring Only - Oral Surgery | 7719290691 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN009884 | GA | MD | Endodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Georgia Endodontic Specialists | Endodontics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Endodontics
- Duluth, GA
- NPI 1174794002
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1197849600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1197849600000",
"number": "1194909820",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9590 MEDLOCK BRIDGE RD",
"address_2": "SUITE G",
"city": "DULUTH",
"state": "GA",
"postal_code": "300974443",
"telephone_number": "770-232-5112",
"fax_number": "770-232-5115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9590 MEDLOCK BRIDGE RD",
"address_2": "SUITE G",
"city": "DULUTH",
"state": "GA",
"postal_code": "300974443",
"telephone_number": "770-232-5112",
"fax_number": "770-232-5115"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RICKOFF",
"first_name": "BRUCE",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-12-17",
"last_updated": "2007-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "GA",
"license": "DN009884",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Duluth, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 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.