Healthcare Provider Details

I. General information

NPI: 1699861906
Provider Name (Legal Business Name): FACIAL SPECTRUM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 NE WINDSOR DR
LEES SUMMIT MO
64086-5594
US

IV. Provider business mailing address

1208 NE WINDSOR DR
LEES SUMMIT MO
64086-5594
US

V. Phone/Fax

Practice location:
  • Phone: 816-524-4334
  • Fax: 816-524-4399
Mailing address:
  • Phone: 816-524-4334
  • Fax: 816-524-4399

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. STEVEN J PRSTOJEVICH
Title or Position: OWNER/SURGEON
Credential: MD DDS
Phone: 816-524-4334