Scott Brookshire

Primary specialty

DentistTaxonomy code 122300000X

License

855 Issued in AK

Practice address

407 Spruce St.
Craig, AK 99921

Phone

(907) 826-2273

NPI assigned

Jun 27, 2013

Last updated

Jun 27, 2013By 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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Southeast Dental Centers Inc.

  • Dentist
  • Craig, AK
  • NPI 1942328042
  NPD (past) Authorized official

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

{
    "created_epoch": "1372291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372291200000",
    "number": "1629418272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 168",
            "city": "CRAIG",
            "state": "AK",
            "postal_code": "999210168",
            "telephone_number": "907-826-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 SPRUCE ST.",
            "city": "CRAIG",
            "state": "AK",
            "postal_code": "99921",
            "telephone_number": "907-826-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROOKSHIRE",
        "first_name": "SCOTT",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-27",
        "last_updated": "2013-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AK",
            "license": "855",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "41359",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALASKA STATE LICENSE NUMBER",
            "identifier": "855",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIF STATE LICENSE NUMBER",
            "identifier": "41359",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patty Sue Boggs, CARE COORDINATOR
• Brenda Marie Bowie, NP
• Ryan Bowser
• Bettina Brentano
• Jessie Brookins
• Victoria Elizabeth Bumgardner, PHARMD
• Casey Bunker
• Eva Christensn
• City of Craig Inc.
• City of Craig, Inc. (Craig Clinic)

• Dentist in Craig, AK
• Providers in Craig, AK by specialty
• Dentist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.