Provider Demographics
NPI:1700403722
Name:KANSAS CITY FACIAL AND ORAL SURGERY, LLC
Entity Type:Organization
Organization Name:KANSAS CITY FACIAL AND ORAL SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL AND MAXILLOFACIAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLABAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DDS
Authorized Official - Phone:816-598-8166
Mailing Address - Street 1:117 SW SHORES DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-4502
Mailing Address - Country:US
Mailing Address - Phone:816-510-5689
Mailing Address - Fax:
Practice Address - Street 1:2931 NE INDEPENDENCE AVE.
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-6406
Practice Address - Country:US
Practice Address - Phone:816-598-8166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty