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General NPI Number Information
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NPI Number | 1942551247
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Entity Type | Organization
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Legal Business Name | KANSAS CITY SURGICAL ARTS LLC
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Dates
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Enumeration Date | 09/26/2012
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Last Update Date | 10/24/2012
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Provider Practice Location Address
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Address Line | 8080 NORTH FLINTLOCK ROAD
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City | KANSAS CITY
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State | MO
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Zip | 64158
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Country | US
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Telephone | 816-286-4126
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Fax | 816-278-5797
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Provider Business Mailing Address
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Address Line | 1428 TIMBER RIDGE DR.
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City | LIBERTY
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State | MO
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Zip | 64068-1126
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Country | US
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Telephone | 816-286-4126
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Fax | 816-278-5797
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DR. MATTHEW ROBERT HLAVACEK
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Credential | MD
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Telephone | 816-286-4126
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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 | 016083
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License Number State | MO
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