Healthcare Provider Details

I. General information

NPI: 1073258414
Provider Name (Legal Business Name): KANSAS CITY CLEFT AND CRANIOFACIAL CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2022
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 W 106TH ST
OVERLAND PARK KS
66215-2305
US

IV. Provider business mailing address

4700 BELLEVIEW AVE STE L10
KANSAS CITY MO
64112-1360
US

V. Phone/Fax

Practice location:
  • Phone: 816-561-1115
  • Fax:
Mailing address:
  • Phone: 605-376-3014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICK CHRISTOPHER
Title or Position: PRESIDENT
Credential: MD, DDS
Phone: 605-376-3014