Provider Demographics
NPI:1659013712
Name:KC ORAL & FACIAL SURGICAL INSTITUTE LLC
Entity Type:Organization
Organization Name:KC ORAL & FACIAL SURGICAL INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PRSTOJEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DDS, FACS
Authorized Official - Phone:816-820-4411
Mailing Address - Street 1:4225 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2304
Mailing Address - Country:US
Mailing Address - Phone:816-753-4225
Mailing Address - Fax:816-753-4226
Practice Address - Street 1:4225 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2304
Practice Address - Country:US
Practice Address - Phone:816-753-4225
Practice Address - Fax:816-753-4226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-10
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery