Provider Demographics
NPI:1780751438
Name:BRUSO, KRISTOPHER J (DDS)
Entity type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:J
Last Name:BRUSO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 MAIN ST STE 306
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64105-2115
Mailing Address - Country:US
Mailing Address - Phone:816-221-8686
Mailing Address - Fax:816-221-5124
Practice Address - Street 1:1111 MAIN ST STE 306
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64105-2115
Practice Address - Country:US
Practice Address - Phone:816-221-8686
Practice Address - Fax:816-221-5124
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0146291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice