Provider Demographics
NPI:1588626659
Name:PRSTOJEVICH, STEVEN J (MD DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:PRSTOJEVICH
Suffix:
Gender:M
Credentials:MD DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 NE WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5594
Mailing Address - Country:US
Mailing Address - Phone:816-524-4334
Mailing Address - Fax:816-524-4399
Practice Address - Street 1:1208 NE WINDSOR DR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5594
Practice Address - Country:US
Practice Address - Phone:816-524-4334
Practice Address - Fax:816-524-4399
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0145861223S0112X
MOR6P66204E00000X
KS04-29863204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0007808Medicare PIN
MOF54865Medicare UPIN