Provider Demographics
NPI:1972691665
Name:BREUCKMANN, KARL A (DDS)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:A
Last Name:BREUCKMANN
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 1:7521 W 143RD TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2316
Mailing Address - Country:US
Mailing Address - Phone:913-814-9455
Mailing Address - Fax:
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
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS71851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice