J. Brent Bartruff, D.M.D.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DN 14824 Issued in FL

Practice address

930 Mar Walt Dr # B
Fort Walton Beach, FL 32547-6706

Phone

(850) 862-6666

NPI assigned

Oct 11, 2006

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1558450585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 MAR WALT DR # B",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476706",
            "telephone_number": "850-862-6666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 MAR WALT DR # B",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476706",
            "telephone_number": "850-862-6666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARTRUFF",
        "first_name": "J. BRENT",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "FL",
            "license": "DN 14824",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENCE",
            "identifier": "DN 14824",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TX ID",
            "identifier": "43800470",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bartlett Family and Cosmetic Dentistry, PLLC (Bright Smiles Family and Cosmetic Dentistry)
• Katherine Jo Bartlett
• Rebecca Bartlett, DPT
• Keilah Marie Barton, DO
• Sherri Barton, APRN
• Svetlana Basenspiler
• Basil D. Fossum, M.D. PA (Basil D. Fossum, M.D.)
• Basil D. Fossum, M.D., F.a.C.S. (Dr. Fossum)
• Basil Fossum MD PA
• Adhithya Baskar, MD

• Periodontics in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Periodontics in Florida

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.