Robert A. Bukowski, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3530 Issued in WI

Practice address

1301 Tower Ave
Superior, WI 54880-1504

Phone

(715) 392-8926

Fax

(715) 392-9107

NPI assigned

Jan 25, 2007

Last updated

Jul 8, 2007By 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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 11, 2016 through Apr 11, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Conkright & Bukowski, LTD.

  • General Practice Dentistry
  • Superior, WI
  • NPI 1770638991
  NPD (past)
• Superior Family Dentistry, SC

  dba Superior Family Dentistry

  • General Practice Dentistry
  • Superior, WI
  • NPI 1821819715
  NPD (past)

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1528113685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 TOWER AVE",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548801504",
            "telephone_number": "715-392-8926",
            "fax_number": "715-392-9107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 TOWER AVE",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548801504",
            "telephone_number": "715-392-8926",
            "fax_number": "715-392-9107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUKOWSKI",
        "first_name": "ROBERT",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "3530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clifford William Bronniche, PHARMD
• Ivie Brooks
• Kacy Lynn Broschofsky
• Kevin Michael Brown, LGSW
• Georgia Dimos Brunette
• Jennifer Ann Bulin, PHARMD
• Ellen Bursch, DDS
• Elizabeth B Byler, MA
• Jarret S Byrnes, ATC
• C R Ross Services LLC

• General Practice Dentistry in Superior, WI
• Providers in Superior, WI by specialty
• General Practice Dentistry in Wisconsin

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.