Provider Demographics
NPI:1154485613
Name:NORTHWEST MISSOURI ORAL & MAXILLOFACIAL SURGEONS
Entity Type:Organization
Organization Name:NORTHWEST MISSOURI ORAL & MAXILLOFACIAL SURGEONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:816-364-4774
Mailing Address - Street 1:3109 FREDERICK AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3073
Mailing Address - Country:US
Mailing Address - Phone:816-364-4774
Mailing Address - Fax:
Practice Address - Street 1:3109 FREDERICK AVE STE A
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3073
Practice Address - Country:US
Practice Address - Phone:816-364-4774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty