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Organization

KENTUCKY CENTER FOR ORAL & MAXILLOFACIAL SURGERY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. REDA S. VAUGHN (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 CIRCLE, SUITE 110, LEXINGTON, KY 40513-1934
(859) 278-9376
(859) 276-0260

Taxonomy

Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7100182700
KY
Enumeration date
02/14/2007
Last updated
09/29/2022
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