# KENTUCKY CENTER FOR ORAL & MAXILLOFACIAL SURGERY PSC

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

## Provider details

- **NPI number:** 1457379307
- **Authorized official:** MRS. REDA S VAUGHN (BUSINESS OFFICE MANAGER)
- **Authorized official phone:** (859) 278-9376

## Contact information

- **Practice address:** 4097 ATWOOD DRIVE, RICHMOND, KY 40475-2454
- **Practice address phone:** (859) 623-7711
- **Practice address fax:** (859) 624-2611
- **Mailing address:** 3159 BEAUMONT CENTRE CIR STE 110, LEXINGTON, KY 40513-1968
- **Mailing address phone:** (859) 278-9376
- **Mailing address fax:** (859) 276-0260

## Taxonomy

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

## Other

- **Enumeration date:** 07/18/2006
- **Last updated:** 10/12/2022