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General NPI Number Information
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NPI Number | 1730460270
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Entity Type | Organization
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Legal Business Name | LAKEWOOD ORAL AND MAXILLOFACIAL SURGERY SPECIALISTS
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Dates
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Enumeration Date | 08/29/2011
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Last Update Date | 08/29/2011
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Provider Practice Location Address
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Address Line | 3600 NE RALPH POWELL RD SUITE D
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City | LEES SUMMIT
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State | MO
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Zip | 64064-2369
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Country | US
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Telephone | 816-554-8300
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Fax | 816-554-8303
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Provider Business Mailing Address
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Address Line | 3600 NE RALPH POWELL RD SUITE D
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City | LEES SUMMIT
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State | MO
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Zip | 64064-2369
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Country | US
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Telephone | 816-554-8300
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Fax | 816-554-8303
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Authorized Official
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Title or Position | MEMBER
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Name | DR. CHRISTOPHER J HAGGERTY
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Credential | DDS, MD
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Telephone | 816-554-8300
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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 | 2002013152
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 60577
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 04-34622
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License Number State | KS
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Taxonomy #4
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 2008034915
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License Number State | MO
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