MEDICARE: BUBON & ASSOCIATES, ORTHODONTICS, SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	4015-15	WI

General Provider Information

NPI Number	:	1316325970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUBON & ASSOCIATES, ORTHODONTICS, SC

Provider Business Mailing Address
First Line	:	N4W21680 BLUEMOUND RD
Second Line	:
City	:	WAUKESHA
State	:	WI
Zip	:	53186-2943
Country	:	US
Telephone Number	:	262-522-7447
Fax Number	:	262-522-7448

Provider Business Practice Location Address
First Line	:	11 CROSSROADS CT
Second Line	:
City	:	DELAFIELD
State	:	WI
Zip	:	53018-2035
Country	:	US
Telephone Number	:	262-522-7447
Fax Number	:	262-522-7448

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL S BUBON
Credential	:	DDS
Telephone Number	:	262-522-7447

Provider Enumeration Date	:	05/14/2015
Last Update Date	:	05/14/2015

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