Individual provider Active NPI

Scott Bradley Craven, D.D.S.

  • General Practice Dentistry
  • Prairie Village, KS
National Provider Identifier
1104804079
Registry record updated Mar 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
60161 Issued in KS
Practice address
5000 W 95TH St
Suite 300
Prairie Village, KS 66207-3383
Phone
(913) 649-0310
NPI assigned
Jan 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 60161 KS Primary

Addresses

Primary practice location

5000 W 95TH St
Suite 300
Prairie Village, KS 66207-3383

Mailing address

5000 W 95TH St
Suite 300
Prairie Village, KS 66207-3383
Phone (816) 560-5561

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20160505002284 KS Order and Referring Only - DentistPractitioner - Dentist 7012216468

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
60161KSMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1136160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394668800000",
    "number": "1104804079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 W 95TH ST",
            "address_2": "SUITE 300",
            "city": "PRAIRIE VILLAGE",
            "state": "KS",
            "postal_code": "662073383",
            "telephone_number": "816-560-5561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 W 95TH ST",
            "address_2": "SUITE 300",
            "city": "PRAIRIE VILLAGE",
            "state": "KS",
            "postal_code": "662073383",
            "telephone_number": "913-649-0310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRAVEN",
        "first_name": "SCOTT",
        "middle_name": "BRADLEY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-02",
        "last_updated": "2014-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KS",
            "license": "60161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prairie Village, KS

Sources for this page

Verify at the official NPI Registry.