NPIMap

Organization Active NPI

Bruick Dentistry PC

  • General Practice Dentistry
  • Fort Wayne, IN
National Provider Identifier
1740448232
Registry record updated May 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
8370 Issued in IN
Legal business name
BRUICK DENTISTRY PC
Practice address
6405 Georgetown North Blvd
Fort Wayne, IN 46815-7007
Phone
(260) 485-0583
Fax
(260) 485-8029
NPI assigned
May 30, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2008

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

Authorized official

Name
Dr. Dwane R Bruick, DDSNPI 1740255991
Title
Owner
Phone
(260) 485-0583

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 8370 IN Primary

Addresses

Primary practice location

6405 Georgetown North Blvd
Fort Wayne, IN 46815-7007

Mailing address

6405 Georgetown North Blvd
Fort Wayne, IN 46815-7007
Phone (260) 485-0583

National Provider Directory

National Provider Directory

Locations

6405 Georgetown North Blvd
Fort Wayne, IN 46815
Phone (260) 485-0583

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1212105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212105600000",
    "number": "1740448232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6405 GEORGETOWN NORTH BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468157007",
            "telephone_number": "260-485-0583",
            "fax_number": "260-485-8029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6405 GEORGETOWN NORTH BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468157007",
            "telephone_number": "260-485-0583",
            "fax_number": "260-485-8029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRUICK DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-30",
        "last_updated": "2008-05-30",
        "status": "A",
        "authorized_official_last_name": "BRUICK",
        "authorized_official_first_name": "DWANE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "260-485-0583",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "8370",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2008; 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.