Active NPI
Ryan Michael Holbrook, DDS
- General Practice Dentistry
- Farmington, MO
National Provider Identifier
1750802997
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2017017277
- Practice address
- 640 W Karsch Blvd
Farmington, MO 63640-3342 - Phone
- (573) 218-0346
- NPI assigned
- Jun 28, 2017
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2017017277 | MO | Primary |
Addresses
Primary practice location
640 W Karsch Blvd
Farmington, MO 63640-3342
Mailing address
422 Lincoln Terrace CT
Fenton, MO 63026-3981
Phone (314) 409-9981
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2017017277 | MO | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1498608000000",
"number": "1750802997",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "422 LINCOLN TERRACE CT",
"city": "FENTON",
"state": "MO",
"postal_code": "630263981",
"telephone_number": "314-409-9981"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "640 W KARSCH BLVD",
"city": "FARMINGTON",
"state": "MO",
"postal_code": "636403342",
"telephone_number": "573-218-0346"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLBROOK",
"first_name": "RYAN",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-06-28",
"last_updated": "2017-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MO",
"license": "2017017277",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Farmington, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.