Provider Demographics
NPI:1023217312
Name:KARL A BREUCKMANN DDS & KAMI L ROSS DDS PA
Entity type:Organization
Organization Name:KARL A BREUCKMANN DDS & KAMI L ROSS DDS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BREUCKMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-782-6533
Mailing Address - Street 1:15095 W 123RD ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-6964
Mailing Address - Country:US
Mailing Address - Phone:913-782-6533
Mailing Address - Fax:913-782-6653
Practice Address - Street 1:15095 W 123RD ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-6964
Practice Address - Country:US
Practice Address - Phone:913-782-6533
Practice Address - Fax:913-782-6653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty