# COMMONWEALTH ORAL AND MAXILLOFACIAL SURGERY, PSC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Commonwealth Oral Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922480250
- **Authorized official:** DR. TIMOTHY ACORD D.D.S. (OWNER, PRESIDENT)
- **Authorized official phone:** (502) 423-7822

## Contact information

- **Practice address:** 6520 GLENRIDGE PARK PL, SUITE 7, LOUISVILLE, KY 40222-3455
- **Practice address phone:** (502) 423-7822
- **Practice address fax:** (502) 423-7830
- **Mailing address:** 6520 GLENRIDGE PARK PL, SUITE 7, LOUISVILLE, KY 40222-3455
- **Mailing address phone:** (502) 423-7822
- **Mailing address fax:** (502) 423-7830

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 8588 | KY | Yes |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | 8588 | KY | — |

## Other

- **Enumeration date:** 06/23/2015
- **Last updated:** 06/23/2015