# EAST KENTUCKY ORAL & MAXILLOFACIAL SURGERY, PSC

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

## Provider details

- **NPI number:** 1962414680
- **Authorized official:** MR. CHAD CLIFTON STREET DMD, MD (OWNER)
- **Authorized official phone:** (606) 432-5983

## Contact information

- **Practice address:** 387 TOWN MOUNTAIN RD, PIKEVILLE, KY 41501-1640
- **Practice address phone:** (606) 432-5983
- **Practice address fax:** (606) 432-9474
- **Mailing address:** PO BOX 2069, PIKEVILLE, KY 41502-2069
- **Mailing address phone:** (606) 432-5983
- **Mailing address fax:** (606) 432-9474

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 7103 | KY | Yes |

## Other

- **Enumeration date:** 08/12/2006
- **Last updated:** 08/22/2020