MEDICARE: DR. STEPHEN E BROTHERSON DDS

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
1	122300000X	Dentist	5207	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811239429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN E BROTHERSON DDS

Provider Business Mailing Address
First Line	:	4116 STRONG AVE
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66106-1946
Country	:	US
Telephone Number	:	913-831-1212
Fax Number	:	913-677-5644

Provider Business Practice Location Address
First Line	:	4116 STRONG AVE
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66106-1946
Country	:	US
Telephone Number	:	913-831-1212
Fax Number	:	913-677-5644

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2013
Last Update Date	:	03/21/2013

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