| Kansas City Cleft And Craniofacial Center Pa | |
|
12200 W 106th St Overland Park KS 66215-2305 | |
| (816) 561-1115 | |
| Not Available |
| Full Name | Kansas City Cleft And Craniofacial Center Pa |
|---|---|
| Speciality | Dentist |
| Location | 12200 W 106th St, Overland Park, Kansas |
| Authorized Official Name and Position | Patrick Christopher (PRESIDENT) |
| Authorized Official Contact | 6053763014 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kansas City Cleft And Craniofacial Center Pa 4700 Belleview Ave Ste L10 Kansas City MO 64112-1360 Ph: (605) 376-3014 | Kansas City Cleft And Craniofacial Center Pa 12200 W 106th St Overland Park KS 66215-2305 Ph: (816) 561-1115 |
| NPI Number | 1073258414 |
|---|---|
| Provider Enumeration Date | 04/30/2022 |
| Last Update Date | 08/14/2024 |
| Medicare PECOS PAC ID | 8820539687 |
|---|---|
| Medicare Enrollment ID | O20240919002590 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073258414 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Ashley R Stansbury |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1922414671 PECOS PAC ID: 0345563771 Enrollment ID: I20241001001469 |
| Provider Name | Zachary Brown |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1114347861 PECOS PAC ID: 1456644764 Enrollment ID: I20241007000165 |
| Provider Name | Nicholas C Anggelis |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1659720027 PECOS PAC ID: 2860787124 Enrollment ID: I20241022003245 |
| Provider Name | Patrick Christopher |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1821402645 PECOS PAC ID: 9335414598 Enrollment ID: I20241023001311 |
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