Organization
KENTUCKY CENTER FOR ORAL & MAXILLOFACIAL SURGERY PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REDA VAUGHN (OFFICE MANAGER)
(859) 278-9376
Entity
Organization
Contact information
Practice address
3159 BEAUMONT CENTRE CIR STE 110, LEXINGTON, KY 40513-1968
(859) 278-9376
(859) 278-9376
Mailing address
3159 BEAUMONT CENTRE CIR STE 110, LEXINGTON, KY 40513-1968
(859) 278-9376
(859) 276-0260
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223P0221X
Pediatric Dentistry
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
07/18/2006
Last updated
09/29/2022
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