# KY TN ORAL SURGERY PLLC

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

## Provider details

- **NPI number:** 1093077166
- **Authorized official:** DR. MICHAEL LEE BOBO DDS, MD (PARTNER/ MEMBER)
- **Authorized official phone:** (270) 759-4063

## Contact information

- **Practice address:** 1109 POPLAR ST, MURRAY, KY 42071-2360
- **Practice address phone:** (270) 759-4063
- **Practice address fax:** (270) 759-4920
- **Mailing address:** 1109 POPLAR ST, MURRAY, KY 42071-2360
- **Mailing address phone:** (270) 759-4063
- **Mailing address fax:** (270) 759-4920

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 7404 | TN | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 7465 | KY | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 8334 | TN | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 8841 | KY | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | 30866 | TN | Yes |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | 34759 | KY | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | 8334 | TN | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | 8841 | KY | — |

## Other

- **Enumeration date:** 06/13/2012
- **Last updated:** 07/11/2012