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Individual
MR. MATTHEW R HLAVACEK
Active
Individual
MR. MATTHEW R HLAVACEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
016083
MO
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
016083
MO
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
2005027155
MO
208D00000X
General Practice Physician
2005027155
MO
Other
Enumeration date
01/10/2006
Last updated
07/30/2012
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