David Bruckner, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

33083 Issued in NY

Practice address

8015 164TH St
Jamaica, NY 11432-1116

Phone

(718) 523-1525

Fax

(718) 523-1747

NPI assigned

May 8, 2007

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 1

Medicare fee-for-service enrollment

Enrolled in NY

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": "1178582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710190368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8015 164TH ST",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114321116",
            "telephone_number": "718-523-1525",
            "fax_number": "718-523-1747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8015 164TH ST",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114321116",
            "telephone_number": "718-523-1525",
            "fax_number": "718-523-1747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUCKNER",
        "first_name": "DAVID",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "33083",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00285965",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tawana L. Brown, PHD
• Tenneau Timeka Brown
• Tierrani Cione Brown
• Zoe Brown
• Bruce Chin,M.D.,P.C.
• Todd Samuel Bruckner, DDS
• Tania Bruneau
• Natasha E Brutus, OTR/L
• Cyan Bryan-Jackson, L.P.N
• Omar Bryan, MA, MHC-LP

• General Practice Dentistry in Jamaica, NY
• Providers in Jamaica, NY by specialty
• General Practice Dentistry in New York

• 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.