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General NPI Number Information
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NPI Number | 1235171059
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Entity Type | Organization
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Legal Business Name | FLACK & STONE, D.D.S., P.C.
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 10/24/2007
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Provider Practice Location Address
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Address Line | 300 W R D MIZE RD SUITE 100
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City | BLUE SPRINGS
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State | MO
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Zip | 64014-2528
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Country | US
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Telephone | 816-229-3737
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Fax | 816-229-1656
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Provider Business Mailing Address
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Address Line | 300 W R D MIZE RD SUITE 100
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City | BLUE SPRINGS
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State | MO
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Zip | 64014-2528
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Country | US
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Telephone | 816-229-3737
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Fax | 816-229-1656
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Authorized Official
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Title or Position | ORAL SURGEON/OWNER
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Name | DR. MARK EDWIN FLACK
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Credential | D.D.S.
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Telephone | 816-229-3737
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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 | 12700
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License Number State | MO
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