Nicole Brubaker, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

019.035468 Issued in IL

Practice address

401 Main St
Savanna, IL 61074-1535

Phone

(815) 273-2212

NPI assigned

May 8, 2023

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Keith Ruter LLC Dba Riverside Dental

  • General Practice Dentistry
  • Savanna, IL
  • NPI 1750640439
  NPD (past)
• Riverside Dental, PC

  • General Practice Dentistry
  • Savanna, IL
  • NPI 1073667184
  NPD (past)

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

{
    "created_epoch": "1683504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723766400000",
    "number": "1992494637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17-148 EDGEWATER DR",
            "city": "LANARK",
            "state": "IL",
            "postal_code": "610469366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 MAIN ST",
            "city": "SAVANNA",
            "state": "IL",
            "postal_code": "610741535",
            "telephone_number": "815-273-2212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUBAKER",
        "first_name": "NICOLE",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-08",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.035468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ams Holdings, LLC
• Ams Holdings, PLLC
• Scott Christian Bares, DDS
• Big Meadows Inc
• Big Meadows, Inc.
• Jeanne Rane Byers Spraetz, MA CCC SLP
• Clinton Physical Therapy Services
• Freeport Regional Health Care Foundation
• Freeport Regional Health Care Foundation
• Taylor Frey

• All providers in Savanna, IL
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2024; 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.