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Organization
GREEN RIVER ORAL SURGERY
Active
Organization
GREEN RIVER ORAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT GENE WAGONER II D.M.D., M.D (OWNER)
(570) 814-3085
Entity
Organization
Contact information
Practice address
801 N ELM ST, HENDERSON, KY 42420-2705
(270) 212-0330
(270) 212-0332
Mailing address
801 N ELM ST, HENDERSON, KY 42420-2705
(270) 212-0330
(270) 212-0332
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
7298
KY
Other
Enumeration date
08/13/2012
Last updated
08/13/2012
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