Provider Demographics
NPI:1942275029
Name:MIDWEST ORAL AND MAXILLOFACIAL SURGERY, P.A.
Entity Type:Organization
Organization Name:MIDWEST ORAL AND MAXILLOFACIAL SURGERY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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:DDS
Authorized Official - Phone:913-334-6000
Mailing Address - Street 1:8919 PARALLEL PKWY
Mailing Address - Street 2:SUITE 480
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-1636
Mailing Address - Country:US
Mailing Address - Phone:913-334-6000
Mailing Address - Fax:913-334-7990
Practice Address - Street 1:8919 PARALLEL PKWY
Practice Address - Street 2:SUITE 480
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-1636
Practice Address - Country:US
Practice Address - Phone:913-334-6000
Practice Address - Fax:913-334-7990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100314930CMedicaid
KS100364740AMedicaid
KSD698368Medicare ID - Type UnspecifiedDR. GREEN ID
KS100314930CMedicaid
KSU70556Medicare UPIN
KSU82100Medicare UPIN