Provider Demographics
NPI:1639767015
Name:JAMES S BREUKER DDS & ASSOCIATES LLC
Entity Type:Organization
Organization Name:JAMES S BREUKER DDS & ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BREUKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-405-2453
Mailing Address - Street 1:511 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:BICKNELL
Mailing Address - State:IN
Mailing Address - Zip Code:47512-9628
Mailing Address - Country:US
Mailing Address - Phone:219-405-2453
Mailing Address - Fax:
Practice Address - Street 1:511 W 11TH ST
Practice Address - Street 2:
Practice Address - City:BICKNELL
Practice Address - State:IN
Practice Address - Zip Code:47512-9628
Practice Address - Country:US
Practice Address - Phone:812-220-0693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-01
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200444920Medicaid