MEDICARE: DR. BRUCE JAMES DERR DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	012189	MO

General Provider Information

NPI Number	:	1528152451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE JAMES DERR DDS

Provider Business Mailing Address
First Line	:	1420 NW VIVION RD
Second Line	:	STE.#107
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-4555
Country	:	US
Telephone Number	:	816-505-0555
Fax Number	:	816-505-2662

Provider Business Practice Location Address
First Line	:	1420 NW VIVION RD
Second Line	:	STE.#107
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-4555
Country	:	US
Telephone Number	:	816-505-0555
Fax Number	:	816-505-2662

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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