MEDICARE: DR. STEVEN J PRSTOJEVICH 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)	014586	MO
2	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	R6P66	MO
3	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	04-29863	KS

General Provider Information

NPI Number	:	1588626659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN J PRSTOJEVICH 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	:	04/04/2006
Last Update Date	:	08/03/2007

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