Provider Demographics
NPI:1023027836
Name:ORAL & FACIAL SURGERY ASSOCIATES
Entity Type:Organization
Organization Name:ORAL & FACIAL SURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-381-5194
Mailing Address - Street 1:PO BOX 411863
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-1863
Mailing Address - Country:US
Mailing Address - Phone:913-381-5194
Mailing Address - Fax:913-381-5215
Practice Address - Street 1:3700 W 83RD ST
Practice Address - Street 2:SUITE 203
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-5121
Practice Address - Country:US
Practice Address - Phone:913-381-5194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS=========OtherFEDERAI TAX ID