Sergiei Brountchenko, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

42278 Issued in CA

Practice address

4577 E Kings Canyon Rd, Suite #102
Fresno, CA 93702-3717

Phone

(559) 454-0777

Fax

(559) 454-0280

NPI assigned

Aug 15, 2005

Last updated

Mar 12, 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1124064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583971200000",
    "number": "1740272970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4577 E KINGS CANYON RD, SUITE #102",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937023717",
            "telephone_number": "559-454-0777",
            "fax_number": "559-454-0280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4577 E KINGS CANYON RD, SUITE #102",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937023717",
            "telephone_number": "559-454-0777",
            "fax_number": "559-454-0280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUNTCHENKO",
        "first_name": "SERGIEI",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-15",
        "last_updated": "2020-03-12",
        "certification_date": "2020-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "42278",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Latonya M Brooks
• Maria Brooks
• Vida Brooks
• Crystal Brookter
• Lisa Marie Brott, LCSW
• Natalie Mae Brower
• La Rhonda Monique Brown-Bradley
• Shanekka Nicole Brown-Johnson, LMFT
• Alison Brown
• Angela Brown, FNP

• General Practice Dentistry in Fresno, CA
• Providers in Fresno, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2020; 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.