Brenton A Reavley, DDS

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

2007014548 Issued in MO

Practice address

4151 N Mulberry Dr
Suite 230
Kansas City, MO 64116-4447

Phone

(816) 326-8204

Fax

(816) 326-8431

NPI assigned

Jun 3, 2009

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Mar 1, 2018 through Mar 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1243987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1248048000000",
    "number": "1780810853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4151 N MULBERRY DR",
            "address_2": "SUITE 230",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641164447",
            "telephone_number": "816-326-8204",
            "fax_number": "816-326-8431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4151 N MULBERRY DR",
            "address_2": "SUITE 230",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641164447",
            "telephone_number": "816-326-8204",
            "fax_number": "816-326-8431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REAVLEY",
        "first_name": "BRENTON",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-03",
        "last_updated": "2009-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2007014548",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "MO",
            "license": "2007014548",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Echo R Reardon, CRNA
• Jane Reardon
• Rachel Michelle Rearrick
• Jamie Renee Reasoner, D.O.
• Daphne A Reavey, RN,ARNP
• Lisa Rebel, OTR/L
• Colleen Recker, LCSW, LSCSW
• Crystal Rose Reckker
• Adam Quinn Recknagel, OD
• Reconciliation Services

• Endodontics in Kansas City, MO
• Providers in Kansas City, MO by specialty
• Endodontics in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2009; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.