Active NPI
Lydia Julianna Bruce, DDS
- Dentist
- Wichita, KS
National Provider Identifier
1104494061
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 61864
- Practice address
- 527 N Grove St
Wichita, KS 67214-4520 - Phone
- (316) 262-2415
- NPI assigned
- Jun 16, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 61864 | KS | Primary |
Addresses
Primary practice location
527 N Grove St
Wichita, KS 67214-4520
Mailing address
3944 N Rushwood St
Wichita, KS 67226-2427
Phone (405) 564-8849
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241003004200 | TX | Order and Referring Only - Oral Surgery | 0042741860 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623801600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623801600000",
"number": "1104494061",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3944 N RUSHWOOD ST",
"city": "WICHITA",
"state": "KS",
"postal_code": "672262427",
"telephone_number": "405-564-8849"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "527 N GROVE ST",
"city": "WICHITA",
"state": "KS",
"postal_code": "672144520",
"telephone_number": "316-262-2415"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUCE",
"first_name": "LYDIA",
"middle_name": "JULIANNA",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-06-16",
"last_updated": "2021-06-16",
"certification_date": "2021-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KS",
"license": "61864",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wichita, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2021; 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.