Active NPI
Bruce Steven Dodge, D.M.D.
- General Practice Dentistry
- Burbank, CA
National Provider Identifier
1306856521
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 28436
- Practice address
- 2800 W Magnolia Blvd
Burbank, CA 91505-3036 - Phone
- (818) 846-9041
- Fax
- (818) 842-4065
- NPI assigned
- Aug 9, 2006
- Last updated
- Jul 16, 2014
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 28436 | CA | Primary |
Addresses
Primary practice location
2800 W Magnolia Blvd
Burbank, CA 91505-3036
Mailing address
1610 Alta Park Lane
La Canada, CA 91011
Phone (818) 624-9074
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 953536282 | Other | CA | TAX IDENTIFICATION NUMBER |
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
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mehrzad Seraji, DDS, Inc. | General Practice | Past | Accepting new patients |
| Bruce S. Dodge, D.M.D., Inc. | General Practice | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- General Practice Dentistry
- Burbank, CA
- NPI 1700296605
-
- General Practice Dentistry
- Burbank, CA
- NPI 1134530488
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405468800000",
"number": "1306856521",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1610 ALTA PARK LANE",
"city": "LA CANADA",
"state": "CA",
"postal_code": "91011",
"telephone_number": "818-624-9074",
"fax_number": "818-842-4065"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2800 W MAGNOLIA BLVD",
"city": "BURBANK",
"state": "CA",
"postal_code": "915053036",
"telephone_number": "818-846-9041",
"fax_number": "818-842-4065"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DODGE",
"first_name": "BRUCE",
"middle_name": "STEVEN",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-09",
"last_updated": "2014-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "28436",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX IDENTIFICATION NUMBER",
"identifier": "953536282",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Burbank, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.