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Organization
EAST KENTUCKY ORAL & MAXILLOFACIAL SURGERY, PSC
Active
Organization
EAST KENTUCKY ORAL & MAXILLOFACIAL SURGERY, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHAD CLIFTON STREET DMD, MD (OWNER)
(606) 432-5983
Entity
Organization
Contact information
Practice address
387 TOWN MOUNTAIN RD, PIKEVILLE, KY 41501-1640
(606) 432-5983
(606) 432-9474
Mailing address
PO BOX 2069, PIKEVILLE, KY 41502-2069
(606) 432-5983
(606) 432-9474
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
7103
KY
Other
Enumeration date
08/12/2006
Last updated
08/22/2020
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