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Organization

SOUTHERN KENTUCKY ORAL SURGERY ASSOCIATES PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
VICKIE ALVEY (CREDENTIALING COORDINATOR)
(270) 783-0064
Entity
Organization

Contact information

Practice address
1802 ROCKINGHAM AVE, BOWLING GREEN, KY 42104-3348
(270) 783-0064
Mailing address
1802 ROCKINGHAM AVE, BOWLING GREEN, KY 42104-3348

Taxonomy

Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7100049450
KY
05
7100049460
KY
Enumeration date
09/26/2007
Last updated
09/21/2021
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