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General NPI Number Information
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NPI Number | 1740140052
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Entity Type | Organization
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Legal Business Name | BRAVE SERIES II
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Dates
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Enumeration Date | 11/18/2025
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 4015 FREDERICK AVE
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City | SAINT JOSEPH
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State | MO
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Zip | 64506-3156
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Country | US
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Telephone | 816-208-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 4015 FREDERICK AVE
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City | SAINT JOSEPH
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State | MO
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Zip | 64506-3156
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LINDA ESLER
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Credential |
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Telephone | 816-459-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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