Stephen E Brotherson, DDS
Individual provider
Active NPI
Dentist · Kansas City, KS
NPI 1811239429 · NPPES record last updated Mar 21, 2013
Key facts
- NPI
- 1811239429
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 5207 (KS)
- Practice address
- 4116 Strong Ave
Kansas City, KS 66106-1946
- Phone
- (913) 831-1212
- Fax
- (913) 677-5644
- NPI assigned
- Mar 21, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|
| I20151202000342 |
KS |
Order and Referring Only - Dentist
Practitioner - Dentist |
1153621818 |
|
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|
| 5207 | KS | MD | Dentist |
Practice roles
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|
| Dentist |
122300000X |
5207 |
KS |
Yes |
Addresses
Primary practice location
4116 Strong Ave
Kansas City, KS 66106-1946
Mailing address
4116 Strong Ave
Kansas City, KS 66106-1946
Phone (913) 831-1212
Other identifiers
| Identifier | Type | State | Issuer |
|---|
| 200260260B | Medicaid | KS | |
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All providers in Kansas City, KS
· Dentist in Kansas