Gina E Bruck, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019025631 Issued in IL

Practice address

607 W Jefferson St
Shorewood, IL 60404-3700

Phone

(815) 725-5991

Fax

(815) 725-1983

NPI assigned

Jul 25, 2006

Sex

Female

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

Enrolled in IL

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

Practice roles

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.

• Shorewood Family Dental Care LLP

  • General Practice Dentistry
  • Shorewood, IL
  • NPI 1033317847
  NPD (past)

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468368000000",
    "number": "1619990264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "607 W JEFFERSON ST",
            "city": "SHOREWOOD",
            "state": "IL",
            "postal_code": "604043700",
            "telephone_number": "815-725-5991",
            "fax_number": "815-725-1983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 W JEFFERSON ST",
            "city": "SHOREWOOD",
            "state": "IL",
            "postal_code": "604043700",
            "telephone_number": "815-725-5991",
            "fax_number": "815-725-1983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUCK",
        "first_name": "GINA",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-25",
        "last_updated": "2016-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019025631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holly Ann Boersma, ATC
• Nicholas Bowe
• Mehrzad Bozorgnia, M.D.
• Christine Briski
• Brookforest Dental Group, P.C.
• Kevin Bueno, PHARMD
• Maria Bullard
• Kaylee Burian, COTA/L
• Jayme Leigh Cabrera, RN
• Caylee A Caldwell, DT

• General Practice Dentistry in Shorewood, IL
• Providers in Shorewood, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2016; 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.