Active NPI
Thomas Samuel Bogusky, D.D.S.
- General Practice Dentistry
- Saint Peters, MO
National Provider Identifier
1669533899
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 11038
- Practice address
- 4125 Mexico Rd
Saint Peters, MO 63376-6410 - Phone
- (636) 447-4080
- Fax
- (636) 447-5764
- NPI assigned
- Dec 12, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 11038 | MO | Primary |
Addresses
Primary practice location
4125 Mexico Rd
Saint Peters, MO 63376-6410
Mailing address
4125 Mexico Rd
Saint Peters, MO 63376-6410
Phone (636) 447-4080
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
| License | State | Type | Specialty |
|---|---|---|---|
| 11038 | MO | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1194739200000",
"number": "1669533899",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4125 MEXICO RD",
"city": "SAINT PETERS",
"state": "MO",
"postal_code": "633766410",
"telephone_number": "636-447-4080",
"fax_number": "636-447-5764"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4125 MEXICO RD",
"city": "SAINT PETERS",
"state": "MO",
"postal_code": "633766410",
"telephone_number": "636-447-4080",
"fax_number": "636-447-5764"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOGUSKY",
"first_name": "THOMAS",
"middle_name": "SAMUEL",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-12",
"last_updated": "2007-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MO",
"license": "11038",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Peters, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 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.