Healthcare Provider Details

I. General information

NPI: 1740140052
Provider Name (Legal Business Name): BRAVE SERIES II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 FREDERICK AVE
SAINT JOSEPH MO
64506-3156
US

IV. Provider business mailing address

4015 FREDERICK AVE
SAINT JOSEPH MO
64506-3156
US

V. Phone/Fax

Practice location:
  • Phone: 816-208-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: LINDA ESLER
Title or Position: OFFICE MANAGER
Credential:
Phone: 816-459-0000