# SOUTHERN KENTUCKY ORAL SURGERY ASSOCIATES PLLC

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

## Provider details

- **NPI number:** 1013104892
- **Authorized official:** VICKIE ALVEY (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (270) 783-0064

## Contact information

- **Practice address:** 1802 ROCKINGHAM AVE, BOWLING GREEN, KY 42104-3348
- **Practice address phone:** (270) 783-0064
- **Mailing address:** 1802 ROCKINGHAM AVE, BOWLING GREEN, KY 42104-3348

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | — | NULL | — |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | — | — | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 09/26/2007
- **Last updated:** 09/21/2021