# KANSAS CITY FACIAL AND ORAL SURGERY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700403722
- **Authorized official:** BRIAN HOLLABAUGH MD, DDS (ORAL AND MAXILLOFACIAL SURGEON)
- **Authorized official phone:** (816) 598-8166

## Contact information

- **Practice address:** 2931 NE INDEPENDENCE AVE., LEES SUMMIT, MO 64064-6406
- **Practice address phone:** (816) 598-8166
- **Mailing address:** 117 SW SHORES DR, LEES SUMMIT, MO 64064-4502
- **Mailing address phone:** (816) 510-5689

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 06/26/2020
- **Last updated:** 06/26/2020