Active NPI
Stuart A Broth, D.D.S.
- Dentist
- Richmond, VA
National Provider Identifier
1831218494
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 0401008293
- Practice address
- 3400 Wicklow LN
Suite B
Richmond, VA 23236-1328 - Phone
- (804) 276-5060
- Fax
- (804) 276-5061
- NPI assigned
- Mar 28, 2007
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 0401008293 | VA | Primary |
Addresses
Primary practice location
3400 Wicklow LN
Suite B
Richmond, VA 23236-1328
Mailing address
3400 Wicklow LN
Suite B
Richmond, VA 23236-1328
Phone (804) 276-5060
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0401008293 | Other | VA | DENTAL LICENSE NUMBER |
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 |
|---|---|---|---|
| 0401008293 | VA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1306972800000",
"number": "1831218494",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3400 WICKLOW LN",
"address_2": "SUITE B",
"city": "RICHMOND",
"state": "VA",
"postal_code": "232361328",
"telephone_number": "804-276-5060",
"fax_number": "804-276-5061"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3400 WICKLOW LN",
"address_2": "SUITE B",
"city": "RICHMOND",
"state": "VA",
"postal_code": "232361328",
"telephone_number": "804-276-5060",
"fax_number": "804-276-5061"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROTH",
"first_name": "STUART",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-28",
"last_updated": "2011-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VA",
"license": "0401008293",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL LICENSE NUMBER",
"identifier": "0401008293",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Richmond, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.