Organization
GEORGETOWN ORAL AND FACIAL SURGERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMY CORNETTE HENDERSON (OFFICE MANAGER)
(859) 971-9722
Entity
Organization
Contact information
Practice address
101 DARBY DR, SUITE 101, GEORGETOWN, KY 40324-8715
(502) 863-5858
(859) 971-9722
Mailing address
972 FIDDLER CREEK WAY, LEXINGTON, KY 40515-6460
(859) 971-9722
(859) 971-9722
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
7379
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1811915622
INDIVIDUAL NPI
KY
Enumeration date
05/11/2009
Last updated
06/02/2009
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