# LAKEWOOD ORAL AND MAXILLOFACIAL SURGERY SPECIALISTS

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

## Provider details

- **NPI number:** 1730460270
- **Authorized official:** DR. CHRISTOPHER J HAGGERTY DDS, MD (MEMBER)
- **Authorized official phone:** (816) 554-8300

## Contact information

- **Practice address:** 3600 NE RALPH POWELL RD, SUITE D, LEES SUMMIT, MO 64064-2369
- **Practice address phone:** (816) 554-8300
- **Practice address fax:** (816) 554-8303
- **Mailing address:** 3600 NE RALPH POWELL RD, SUITE D, LEES SUMMIT, MO 64064-2369
- **Mailing address phone:** (816) 554-8300
- **Mailing address fax:** (816) 554-8303

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 2002013152 | MO | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 60577 | KS | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | 04-34622 | KS | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | 2008034915 | MO | Yes |

## Other

- **Enumeration date:** 08/29/2011
- **Last updated:** 08/29/2011