| Kentucky Center For Oral & Maxillofacial Surgery Psc | |
|
4097 Atwood Drive Richmond KY 40475-2454 | |
| (859) 623-7711 | |
| (859) 624-2611 |
| Full Name | Kentucky Center For Oral & Maxillofacial Surgery Psc |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 4097 Atwood Drive, Richmond, Kentucky |
| Authorized Official Name and Position | Reda S Vaughn (BUSINESS OFFICE MANAGER) |
| Authorized Official Contact | 8592789376 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kentucky Center For Oral & Maxillofacial Surgery Psc 3159 Beaumont Centre Cir Ste 110 Lexington KY 40513-1968 Ph: (859) 278-9376 | Kentucky Center For Oral & Maxillofacial Surgery Psc 4097 Atwood Drive Richmond KY 40475-2454 Ph: (859) 623-7711 |
| NPI Number | 1457379307 |
|---|---|
| Provider Enumeration Date | 07/18/2006 |
| Last Update Date | 10/12/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457379307 | NPI | - | NPPES |
| 7100182680 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (Kentucky) | Primary |
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