# THAD R. SCHULTEN PSC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** KENTUCKY CENTER FOR ORAL & MAXILLOFACIAL SURGERY
- **Other names:** Kentucky Center for Oral & Maxillofacial Surgery, Kentucky Center for Oral & Maxillofacial Surgery PSC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1235329400
- **Legal business name:** KENTUCKY CENTER FOR ORAL & MAXILLOFACIAL SURGERY
- **Authorized official:** PENNY BOONE (OFFICE MANAGER)
- **Authorized official phone:** (502) 361-0134

## Contact information

- **Practice address:** 4515 CHURCHMAN AVE., LOUISVILLE, KY 40215
- **Practice address phone:** (502) 361-0134
- **Practice address fax:** (502) 361-0137
- **Mailing address:** 4515 CHURCHMAN AVE., LOUISVILLE, KY 40215
- **Mailing address phone:** (502) 361-0134
- **Mailing address fax:** (502) 361-0137

## Taxonomy

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

## Other

- **Enumeration date:** 07/25/2007
- **Last updated:** 09/11/2024