# KENTUCKY CENTER FOR ORAL & MAXILLOFACIAL SURGERY

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

## Provider details

- **NPI number:** 1053453043
- **Authorized official:** MS. REDA VAUGHN (OFFICE MANAGER)
- **Authorized official phone:** (859) 278-9376

## Contact information

- **Practice address:** 3159 BEAUMONT CENTRE CIRCLE, SUITE 110, LEXINGTON, KY 40513-1934
- **Practice address phone:** (859) 278-9376
- **Practice address fax:** (859) 276-0260
- **Mailing address:** 3159 BEAUMONT CENTRE CIRCLE, SUITE 110, LEXINGTON, KY 40513-1934
- **Mailing address phone:** (859) 278-9376
- **Mailing address fax:** (859) 276-0260

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | NULL | Yes |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | — | Yes |

## Other

- **Enumeration date:** 02/13/2007
- **Last updated:** 09/29/2022