Healthcare Provider Details

I. General information

NPI: 1942551247
Provider Name (Legal Business Name): KANSAS CITY SURGICAL ARTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8080 NORTH FLINTLOCK ROAD
KANSAS CITY MO
64158
US

IV. Provider business mailing address

1428 TIMBER RIDGE DR.
LIBERTY MO
64068-1126
US

V. Phone/Fax

Practice location:
  • Phone: 816-286-4126
  • Fax: 816-278-5797
Mailing address:
  • Phone: 816-286-4126
  • Fax: 816-278-5797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number016083
License Number StateMO

VIII. Authorized Official

Name: DR. MATTHEW ROBERT HLAVACEK
Title or Position: OWNER/OPERATOR
Credential: MD
Phone: 816-286-4126