# GEORGETOWN ORAL AND FACIAL SURGERY, LLC

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

## Provider details

- **NPI number:** 1609000272
- **Authorized official:** MRS. AMY CORNETTE HENDERSON (OFFICE MANAGER)
- **Authorized official phone:** (859) 971-9722

## Contact information

- **Practice address:** 101 DARBY DR, SUITE 101, GEORGETOWN, KY 40324-8715
- **Practice address phone:** (502) 863-5858
- **Practice address fax:** (859) 971-9722
- **Mailing address:** 972 FIDDLER CREEK WAY, LEXINGTON, KY 40515-6460
- **Mailing address phone:** (859) 971-9722
- **Mailing address fax:** (859) 971-9722

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 7379 | KY | Yes |

## Other

- **Enumeration date:** 05/11/2009
- **Last updated:** 06/02/2009