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NPI Code Detail

MEDICARE: DR. BRANDI KATHLEEN ROEBER D.D.S.

MEDICARE: DR. BRANDI KATHLEEN ROEBER D.D.S.
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
1122300000XDentist6697NE
21223P0221XPediatric Dentistry2010015177MO

General Provider Information

NPI Number : 1730375064
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRANDI KATHLEEN ROEBER D.D.S.
Provider Business Mailing Address
First Line : 230 NW 72ND ST
Second Line :
City : GLADSTONE
State : MO
Zip : 64118-1898
Country : US
Telephone Number : 816-436-5900
Fax Number : 816-436-5985
Provider Business Practice Location Address
First Line : 231 NW 72ND ST
Second Line :
City : GLADSTONE
State : MO
Zip : 64118-1821
Country : US
Telephone Number : 816-436-5900
Fax Number : 816-436-5985
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2007
Last Update Date : 06/16/2010

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