NPIMap

Organization Active NPI

Bradley D. Bourcy DDS Ms and Ryan D. Harbertson DDS Ms

  • Periodontics
  • Escondido, CA
National Provider Identifier
1417967290
Registry record updated Jan 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
042637 Issued in CA
Legal business name
BRADLEY D. BOURCY DDS MS AND RYAN D. HARBERTSON DDS MS
Practice address
850 E. Grand Avenue
Suite a
Escondido, CA 92025-3435
Phone
(760) 741-4061
Fax
(760) 432-8764
NPI assigned
Aug 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2014

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

Authorized official

Name
Ryan D. Harbertson, D.D.S., M.S.NPI 1073765053
Title
Owner/Partner
Phone
(760) 741-4061

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X 042637 CA Primary

Addresses

Primary practice location

850 E. Grand Avenue
Suite a
Escondido, CA 92025-3435

Mailing address

850 E. Grand Avenue
Suite a
Escondido, CA 92025-3435
Phone (760) 741-4061

Other names 1

  • David L. Tagge, D.D.S., M.S.D. and Bradley D. Bourcy, D.D.S., M.S., In Former legal business name

National Provider Directory

National Provider Directory

Locations

850 E Grand Ave
Ste A
Escondido, CA 92025
Phone (760) 741-4061

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389312000000",
    "number": "1417967290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 E. GRAND AVENUE",
            "address_2": "SUITE A",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920253435",
            "telephone_number": "760-741-4061",
            "fax_number": "760-432-8764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 E. GRAND AVENUE",
            "address_2": "SUITE A",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920253435",
            "telephone_number": "760-741-4061",
            "fax_number": "760-432-8764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRADLEY D. BOURCY DDS MS AND RYAN D. HARBERTSON DDS MS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-08",
        "last_updated": "2014-01-10",
        "status": "A",
        "authorized_official_last_name": "HARBERTSON",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "OWNER/PARTNER",
        "authorized_official_telephone_number": "760-741-4061",
        "authorized_official_credential": "D.D.S., M.S."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "042637",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "David L. Tagge, D.D.S., M.S.D. and Bradley D. Bourcy, D.D.S., M.S., In",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Escondido, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 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.

Verify at the official NPI Registry.