MEDICARE: MR. MATTHEW R HLAVACEK MD, 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	016083	MO
2	208D00000X	General Practice Physician	2005027155	MO
3	122300000X	Dentist	016083	MO
4	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	2005027155	MO

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285613240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW R HLAVACEK MD, DDS

Provider Business Mailing Address
First Line	:	1208 NE WINDSOR DR
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64086-5594
Country	:	US
Telephone Number	:	816-524-4334
Fax Number	:	816-524-4399

Provider Business Practice Location Address
First Line	:	1208 NE WINDSOR DR
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64086-5594
Country	:	US
Telephone Number	:	816-524-4334
Fax Number	:	816-524-4399

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

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	07/30/2012

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