Brent Lee Crenshaw, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019.032764 Issued in IL

Practice address

8859 Ladue Rd
Saint Louis, MO 63124-2045

Phone

(314) 983-8011

NPI assigned

Jul 22, 2020

Last updated

Aug 12, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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 MO

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

State licenses

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.

• Bryan Watanabe DDS Ladue Dental Group, PC

  dba Ladue Dental Group

  • General Practice Dentistry
  • Ladue, MO
  • NPI 1851784490
  NPD (past)

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

{
    "created_epoch": "1595376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723420800000",
    "number": "1114535457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 WILLIAMSBURG LN",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620341100",
            "telephone_number": "618-334-6373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8859 LADUE RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631242045",
            "telephone_number": "314-983-8011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRENSHAW",
        "first_name": "BRENT",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-22",
        "last_updated": "2024-08-12",
        "certification_date": "2024-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2020021490",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.032764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristin Crees, PHARMD
• Zachary David Crees, MD
• Aaron James Cregger, D.D.S.
• Toby Ann Cremer
• Crenshaw Medical Supply LLC
• Jessica Crenshaw
• Patricia L Crenshaw, M.ED., LPC
• Shirley Diane Crenshaw, MSW, L.C.S.W.
• Zachary Crenshaw, DO
• Louis F Crepps, M.D.

• General Practice Dentistry in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2024; 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.