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NPI Code Detail

MEDICARE: KRISTOPHER J. BRUSO D.D.S.

MEDICARE: KRISTOPHER J. BRUSO 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
11223G0001XGeneral Practice Dentistry014629MO

General Provider Information

NPI Number : 1780751438
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTOPHER J. BRUSO D.D.S.
Provider Business Mailing Address
First Line : 1111 MAIN ST STE 306
Second Line :
City : KANSAS CITY
State : MO
Zip : 64105-2115
Country : US
Telephone Number : 816-221-8686
Fax Number : 816-221-5124
Provider Business Practice Location Address
First Line : 1111 MAIN ST STE 306
Second Line :
City : KANSAS CITY
State : MO
Zip : 64105-2115
Country : US
Telephone Number : 816-221-8686
Fax Number : 816-221-5124
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2006
Last Update Date : 07/08/2007

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