Louis C Boryc, DDS
Individual provider Active NPI General Practice Dentistry · Butler, WI
NPI 1770686362 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1770686362
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 5001164G (WI)
- Practice address
- 13195 W Hampton Ave
Butler, WI 53007-1609 - Phone
- (262) 781-9585
- Fax
- (262) 783-4409
- NPI assigned
- Sep 7, 2006
- 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 May 27, 2016 through May 27, 2028
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5001164G | WI | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 5001164G | WI | Yes |
Addresses
Primary practice location
13195 W Hampton Ave
Butler, WI 53007-1609
Mailing address
13195 W Hampton Ave
Butler, WI 53007-1609
Phone (262) 781-9585
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33506000 | Medicaid | WI |
Other providers in Butler, WI
- Whitney Amos-Sikora
- Aurora Pharmacy Inc
- Jena Caprioli
- Donald E Dlouhy
- Laura Ann Dolphin
- Donald E. Dlouhy LLC
- Guardian Personal Care Services, LLC
All providers in Butler, WI · General Practice Dentistry in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.