Tanner D Brock, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

61221 Issued in KS

Practice address

2981 N. Webb Rd.
Wichita, KS 67226

Phone

(316) 685-2731

Fax

(316) 685-6946

NPI assigned

Jun 21, 2016

Last updated

Apr 14, 2020By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in KS

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

Practice roles

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

• Kansas Periodontics & Dental Implants LLC

  • Periodontics
  • Wichita, KS
  • NPI 1245328236
  NPD (past)

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

{
    "created_epoch": "1466467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586822400000",
    "number": "1053761072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2981 N. WEBB RD.",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "67226",
            "telephone_number": "316-685-2731",
            "fax_number": "316-685-6946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2981 N. WEBB RD.",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "67226",
            "telephone_number": "316-685-2731",
            "fax_number": "316-685-6946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCK",
        "first_name": "TANNER",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-06-21",
        "last_updated": "2020-04-14",
        "certification_date": "2020-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KS",
            "license": "61221",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "KS",
            "license": "61221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Broadway Home Medical, Inc
• Broadway Pharmacy PA
• Katilyn C Broberg, OD
• Brock L. McKay LLC
• Lindsay C Brock, LMFT
• Taylor Nicole Brock, DDS
• Jenna Brockel
• Manuel Brockman, MD
• Mindy Brockmeyer
• Ashley L Brockus, LMFT

• Periodontics in Wichita, KS
• Providers in Wichita, KS by specialty
• Periodontics in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2020; 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.