NPIMap

Individual provider Active NPI

Michael S Bubon, DDS

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Waukesha, WI
National Provider Identifier
1265497564
Registry record updated Oct 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
4015 Issued in WI
Practice address
N16W24132 Prairie CT
Suite 150
Waukesha, WI 53188-1178
Phone
(262) 522-7447
Fax
(262) 522-7448
NPI assigned
Apr 19, 2006
Last updated
Oct 22, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 4015 WI Primary

Addresses

Primary practice location

N16W24132 Prairie CT
Suite 150
Waukesha, WI 53188-1178

Mailing address

N16W24132 Prairie CT
Suite 150
Waukesha, WI 53188-1178
Phone (262) 522-7447

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)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Diamond Plus Orthodontics by Bubon Orthodontics Orthodontics and Dentofacial Orthopedics Current Accepting new patients

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1256169600000",
    "number": "1265497564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N16W24132 PRAIRIE CT",
            "address_2": "SUITE 150",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531881178",
            "telephone_number": "262-522-7447",
            "fax_number": "262-522-7448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N16W24132 PRAIRIE CT",
            "address_2": "SUITE 150",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531881178",
            "telephone_number": "262-522-7447",
            "fax_number": "262-522-7448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUBON",
        "first_name": "MICHAEL",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-19",
        "last_updated": "2009-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "WI",
            "license": "4015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2009; 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.