Organization
TRI-STATE ORAL & FACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL D. COURCHO DMD, MD (PRESIDENT)
(606) 329-1115
Entity
Organization
Contact information
Practice address
2844 CARTER AVE, ASHLAND, KY 41101-1917
(606) 329-1115
Mailing address
2844 CARTER AVE, ASHLAND, KY 41101-1917
(606) 329-1115
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
34851
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
61900452
—
KY
05
—
65935769
—
KY
Enumeration date
05/27/2008
Last updated
05/27/2008
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