Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 014586 | MO |
N | 204E00000X | Oral & Maxillofacial Surgeon | 04-29863 | KS |
N | 204E00000X | Oral & Maxillofacial Surgeon | R6P66 | MO |
NPI | 1588626659 |
---|---|
Provider Name | Dr. Steven J Prstojevich |
First Address | Lees Summit, MO 64086-5594 |
Second Address | Lees Summit, MO 64086-5594 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2006 |
Last Update Date | 03/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F54865 | (02) | MO |