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General NPI Number Information
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NPI Number | 1154485613
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Entity Type | Organization
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Legal Business Name | NORTHWEST MISSOURI ORAL & MAXILLOFACIAL SURGEONS
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 09/21/2016
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Provider Practice Location Address
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Address Line | 3109 FREDERICK AVE STE A
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City | SAINT JOSEPH
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State | MO
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Zip | 64506-3073
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Country | US
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Telephone | 816-364-4774
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Fax |
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Provider Business Mailing Address
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Address Line | 3109 FREDERICK AVE STE A
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City | SAINT JOSEPH
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State | MO
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Zip | 64506-3073
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Country | US
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Telephone | 816-364-4774
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | RONALD W TAYLOR
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Credential | DDS, MS
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Telephone | 816-364-4774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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