Healthcare Provider Details

I. General information

NPI: 1235150913
Provider Name (Legal Business Name): STEPHEN WAYNE BRUMIT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 SW 3RD ST SUITE E
LEES SUMMIT MO
64063-2258
US

IV. Provider business mailing address

519 SW 3RD ST SUITE E
LEES SUMMIT MO
64063-2258
US

V. Phone/Fax

Practice location:
  • Phone: 816-554-0022
  • Fax: 816-554-0052
Mailing address:
  • Phone: 816-554-0022
  • Fax: 816-554-0052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number14529
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: