Bret A Bologna, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12009795 Issued in IN

Practice address

11039 Broadway
Suite a
Crown Point, IN 46307-8834

Phone

(219) 663-7193

Fax

(219) 663-7833

NPI assigned

Mar 20, 2007

Last updated

Oct 16, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

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": "1174348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350345600000",
    "number": "1922123637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11039 BROADWAY",
            "address_2": "SUITE A",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463078834",
            "telephone_number": "219-663-7193",
            "fax_number": "219-663-7833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11039 BROADWAY",
            "address_2": "SUITE A",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463078834",
            "telephone_number": "219-663-7193",
            "fax_number": "219-663-7833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLOGNA",
        "first_name": "BRET",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-20",
        "last_updated": "2012-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12009795",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mariya Bodnar, DMD
• Sheila Kay Bogart, OD
• Michael Jason Bohney, PA-C
• Tabitha Bolden, MS.
• Ketti R Boller, D.D.S, M.S
• Michelle R Bonadies, LCSW
• Artricia Desiree Bonaparte
• Suzanne Jean Bonaventura-Krischke, MSW
• Neeru Bose, M.D
• David Boss, DPT

• General Practice Dentistry in Crown Point, IN
• Providers in Crown Point, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2012; 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.