Organization
FACIAL SURGERY GROUP PC
Active
Other names
Tanner and Moore
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LOUANN ALLEN (PRACTICE MANAGER)
(816) 561-1115
Entity
Organization
Contact information
Practice address
4700 BELLEVIEW, STE L 10, KANSAS CITY, MO 64112-1360
(816) 561-1115
(816) 931-7912
Mailing address
PO BOX 802752, KANSAS CITY, MO 64180-0001
(816) 561-1115
(816) 753-4493
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DE015216
MO
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DE015905
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27056013
BCBS OF KCMO
MO
Enumeration date
07/20/2006
Last updated
08/22/2020
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