Individual
MR. MATTHEW R HLAVACEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, DDS
Contact information
Practice address
1208 NE WINDSOR DR, LEES SUMMIT, MO 64086-5594
(816) 524-4334
(816) 524-4399
Mailing address
1208 NE WINDSOR DR, LEES SUMMIT, MO 64086-5594
(816) 524-4334
(816) 524-4399
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
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
204017107
—
MO
05
—
404017105
—
MO
Enumeration date
01/10/2006
Last updated
07/30/2012
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