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Organization
KENTUCKIANA ORAL & MAXILLOFACIAL SURGERY ASSOC PSC
Active
Organization
KENTUCKIANA ORAL & MAXILLOFACIAL SURGERY ASSOC PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NATHAN F WALTERS DMD (PRESIDENT)
(502) 454-4885
Entity
Organization
Contact information
Practice address
2800 CANNONS LN, STE 200, LOUISVILLE, KY 40205
(502) 454-4885
(502) 452-1926
Mailing address
2800 CANNONS LN, STE 200, LOUISVILLE, KY 40205
(502) 454-4885
(502) 452-1926
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
KY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
KY
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
KY
Other
Enumeration date
08/18/2005
Last updated
02/06/2018
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