NPIMap

Individual provider Active NPI

Bruce A Boretsky, DMD

  • Periodontics
  • Columbus, GA
National Provider Identifier
1689916504
Registry record updated Mar 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
DN012109 Issued in GA
Practice address
7310 N Lake Dr
Suite C
Columbus, GA 31909-1698
Phone
(706) 653-2600
Fax
(706) 494-1000
NPI assigned
Mar 18, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 18, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Periodontics 1223P0300X DN012109 GA Primary

Addresses

Primary practice location

7310 N Lake Dr
Suite C
Columbus, GA 31909-1698

Mailing address

7310 N Lake Dr
Suite C
Columbus, GA 31909-1698
Phone (706) 653-2600

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

LicenseStateTypeSpecialty
DN012109GAMDPeriodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Bruce a Boretsky DMD, LLC Periodontics Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1363564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363564800000",
    "number": "1689916504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7310 N LAKE DR",
            "address_2": "SUITE C",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319091698",
            "telephone_number": "706-653-2600",
            "fax_number": "706-494-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7310 N LAKE DR",
            "address_2": "SUITE C",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319091698",
            "telephone_number": "706-653-2600",
            "fax_number": "706-494-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORETSKY",
        "first_name": "BRUCE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-03-18",
        "last_updated": "2013-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "GA",
            "license": "DN012109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.