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General NPI Number Information
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NPI Number | 1972089118
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Entity Type | Organization
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Legal Business Name | SUMMIT INTEGRATIVE DENTAL (BROMLEY, D.D.S. AND BROYLES, D.D.S.), P.C.
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Dates
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Enumeration Date | 07/11/2018
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Last Update Date | 07/11/2018
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Provider Practice Location Address
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Address Line | 688 SE BAYBERRY LANE SUITE 101
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City | LEE'S SUMMIT
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State | MO
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Zip | 64063
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Country | US
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Telephone | 816-525-5257
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Fax |
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Provider Business Mailing Address
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Address Line | 688 SE BAYBERRY LANE SUITE 101
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City | LEE'S SUMMIT
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State | MO
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Zip | 64063
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Country | US
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Telephone | 816-525-5257
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | ERIN BROMLEY
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Credential | DDS
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Telephone | 816-525-5257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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