Individual provider Active NPI

Michael William Buskirk, DDS

  • General Practice Dentistry
  • La Mesa, CA
National Provider Identifier
1487790978
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
B31215 Issued in CA
Practice address
3855 Avocado Blvd
Ste 260
La Mesa, CA 91941
Phone
(619) 670-1706
Fax
(619) 670-1860
NPI assigned
Jan 30, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X B31215 CA Primary

Addresses

Primary practice location

3855 Avocado Blvd
Ste 260
La Mesa, CA 91941

Mailing address

3855 Avocado Blvd
Ste 260
La Mesa, CA 91941
Phone (619) 670-1706

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

State licenses

LicenseStateTypeSpecialty
B31215CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
K Tej Dental Inc General Practice PastSince Feb 4, 2024 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.

NPI Registry JSON

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1487790978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3855 AVOCADO BLVD",
            "address_2": "STE 260",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "91941",
            "telephone_number": "619-670-1706",
            "fax_number": "619-670-1860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3855 AVOCADO BLVD",
            "address_2": "STE 260",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "91941",
            "telephone_number": "619-670-1706",
            "fax_number": "619-670-1860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSKIRK",
        "first_name": "MICHAEL",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "B31215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Mesa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.