Provider Demographics
NPI:1497133060
Name:BUBON & ASSOCIATES, ORTHODONTICS, SC
Entity Type:Organization
Organization Name:BUBON & ASSOCIATES, ORTHODONTICS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BUBON
Authorized Official - Suffix:
Authorized Official - Credentials:D
Authorized Official - Phone:262-522-7447
Mailing Address - Street 1:N4W21680 BLUEMOUND RD
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-2943
Mailing Address - Country:US
Mailing Address - Phone:262-522-7447
Mailing Address - Fax:262-522-7448
Practice Address - Street 1:17185 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4428
Practice Address - Country:US
Practice Address - Phone:262-522-7447
Practice Address - Fax:262-522-7448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4015-151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty