Organization
KENTUCKY CENTER FOR ORAL & MAXILLOFACIAL SURGERY PSC
Active
Organization
KENTUCKY CENTER FOR ORAL & MAXILLOFACIAL SURGERY PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. REDA S VAUGHN (BUSINESS OFFICE MANAGER)
(859) 278-9376
Entity
Organization
Contact information
Practice address
4097 ATWOOD DRIVE, RICHMOND, KY 40475-2454
(859) 623-7711
(859) 624-2611
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
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100182680
—
KY
Enumeration date
07/18/2006
Last updated
10/12/2022
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