Bruce A Brandolin, DDS
Individual provider Active NPI Dentist · Yorktown Heights, NY
NPI 1669686176 · NPPES record last updated Aug 9, 2021
Key facts
- NPI
- 1669686176
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 039187 (NY)
- Practice address
- 45 Wellington CT
Yorktown Heights, NY 10598-5923 - Phone
- (914) 907-5187
- NPI assigned
- May 10, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
- Opted out of Medicare
- Yes, effective Jun 30, 2015 through Jun 30, 2027
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 039187 | NY | Yes |
Addresses
Primary practice location
45 Wellington CT
Yorktown Heights, NY 10598-5923
Mailing address
45 Wellington CT
Yorktown Heights, NY 10598-5923
Phone (914) 907-5187
Other providers in Yorktown Heights, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 9, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.