NPIMap

Organization Active NPI

Missouri Dental Professionals, Richard Straus, DMD, PC

Doing business as Brevco Family Dentistry

  • General Practice Dentistry
  • Lake Saint Louis, MO
National Provider Identifier
1972791986
Registry record updated Apr 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
13950 Issued in MO
Legal business name
MISSOURI DENTAL PROFESSIONALS, RICHARD STRAUS, DMD, PC
Doing business as
Brevco Family Dentistry
Practice address
100 Brevco Plaza
Suite 104
Lake Saint Louis, MO 63367
Phone
(636) 561-9000
Fax
(636) 561-9001
NPI assigned
Oct 4, 2007
Last updated
Apr 26, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
MISSOURI DENTAL PROFESSIONALS, RICHARD STRAUS, DMD, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 26, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kendra Walker
Title
Credentialing Team Lead
Phone
(217) 540-8513

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 13950 MO Primary

Addresses

Primary practice location

100 Brevco Plaza
Suite 104
Lake Saint Louis, MO 63367

Mailing address

100 Brevco Plaza
Suite 104
Lake Saint Louis, MO 63367
Phone (636) 561-9000

Other names 1

  • Brevco Family Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Heartland Family Dental Care of Missouri - Richard E Workman DMD PC60 organizations share this tax ID, including this one
Part of
Heartland Family Dental Care of Missouri - Richard E Workman DMD PC

Organizations with this tax ID in the same state 14

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 14

Locations

100 Brevco Plz
Ste 104
Lake St Louis, MO 63367
Phone (636) 212-9197

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1191456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524700800000",
    "number": "1972791986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 BREVCO PLAZA",
            "address_2": "SUITE 104",
            "city": "LAKE SAINT LOUIS",
            "state": "MO",
            "postal_code": "63367",
            "telephone_number": "636-561-9000",
            "fax_number": "636-561-9001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BREVCO PLAZA",
            "address_2": "SUITE 104",
            "city": "LAKE SAINT LOUIS",
            "state": "MO",
            "postal_code": "63367",
            "telephone_number": "636-561-9000",
            "fax_number": "636-561-9001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSOURI DENTAL PROFESSIONALS, RICHARD STRAUS, DMD, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MISSOURI DENTAL PROFESSIONALS, RICHARD STRAUS, DMD, PC",
        "enumeration_date": "2007-10-04",
        "last_updated": "2018-04-26",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "KENDRA",
        "authorized_official_title_or_position": "CREDENTIALING TEAM LEAD",
        "authorized_official_telephone_number": "217-540-8513"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "13950",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brevco Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Brevco Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2018; 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.