| Commonwealth Oral Surgery | |
|
6520 Glenridge Park Pl Suite 7 Louisville KY 40222-3455 | |
| (502) 423-7822 | |
| (502) 423-7830 |
| Full Name | Commonwealth Oral Surgery |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 6520 Glenridge Park Pl, Louisville, Kentucky |
| Authorized Official Name and Position | Timothy Acord (OWNER, PRESIDENT) |
| Authorized Official Contact | 5024237822 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Commonwealth Oral Surgery 6520 Glenridge Park Pl Suite 7 Louisville KY 40222-3455 Ph: (502) 423-7822 | Commonwealth Oral Surgery 6520 Glenridge Park Pl Suite 7 Louisville KY 40222-3455 Ph: (502) 423-7822 |
| NPI Number | 1922480250 |
|---|---|
| Provider Enumeration Date | 06/23/2015 |
| Last Update Date | 06/23/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922480250 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 8588 (Kentucky) | Primary |
| 204E00000X | Oral & Maxillofacial Surgery | 8588 (Kentucky) | Secondary |
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