Provider Demographics
NPI:1114162104
Name:MIDWEST ORAL & MAXILLOFACIAL SURGERY, PA
Entity Type:Organization
Organization Name:MIDWEST ORAL & MAXILLOFACIAL SURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.D.S.
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-334-6000
Mailing Address - Street 1:11551 GRANADA LANE
Mailing Address - Street 2:100
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1914
Mailing Address - Country:US
Mailing Address - Phone:913-491-4488
Mailing Address - Fax:913-491-5073
Practice Address - Street 1:11551 GRANADA LANE
Practice Address - Street 2:100
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1914
Practice Address - Country:US
Practice Address - Phone:913-491-4488
Practice Address - Fax:913-491-5073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-05
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty