Charles Bukovac, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2012029542 Issued in MO

Practice address

215 South Sturgeon St
Montgomery City, MO 63361

Phone

(573) 564-3726

NPI assigned

Dec 5, 2012

Last updated

Dec 5, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1354665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354665600000",
    "number": "1508101338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1687 DOVE RD",
            "city": "SORENTO",
            "state": "IL",
            "postal_code": "620863254",
            "telephone_number": "618-604-2111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 SOUTH STURGEON ST",
            "city": "MONTGOMERY CITY",
            "state": "MO",
            "postal_code": "63361",
            "telephone_number": "573-564-3726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUKOVAC",
        "first_name": "CHARLES",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-12-05",
        "last_updated": "2012-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2012029542",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cary Leland Baney, DC
• Kristina Boylan, FNP
• Bristol Care, Inc.
• Michelle Marie Burski
• Carolyn Sue Canterbury, NP
• Tammi Carter
• Cary Baney (County Chiropractic)
• Mike Cheng

• General Practice Dentistry in Montgomery City, MO
• Providers in Montgomery City, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2012; 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.