Healthcare Provider Details

I. General information

NPI: 1659013712
Provider Name (Legal Business Name): KC ORAL & FACIAL SURGICAL INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2022
Last Update Date: 04/10/2022
Certification Date: 04/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 BALTIMORE AVE
KANSAS CITY MO
64111-2304
US

IV. Provider business mailing address

4225 BALTIMORE AVE
KANSAS CITY MO
64111-2304
US

V. Phone/Fax

Practice location:
  • Phone: 816-753-4225
  • Fax: 816-753-4226
Mailing address:
  • Phone: 816-753-4225
  • Fax: 816-753-4226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN J PRSTOJEVICH
Title or Position: OWNER
Credential: MD, DDS, FACS
Phone: 816-820-4411