Provider Demographics
NPI:1285808840
Name:CHARLES F. BREUSING, D.D.S.,PC
Entity type:Organization
Organization Name:CHARLES F. BREUSING, D.D.S.,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ENGLEBRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-561-2800
Mailing Address - Street 1:411 NICHOLS RD
Mailing Address - Street 2:SUITE 241
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-2000
Mailing Address - Country:US
Mailing Address - Phone:816-561-2800
Mailing Address - Fax:
Practice Address - Street 1:411 NICHOLS RD
Practice Address - Street 2:SUITE 241
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-2000
Practice Address - Country:US
Practice Address - Phone:816-561-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO115761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty