| Southern Kentucky Oral Surgery Associates Pllc | |
|
1802 Rockingham Ave Bowling Green KY 42104-3348 | |
| (270) 783-0064 | |
| Not Available |
| Full Name | Southern Kentucky Oral Surgery Associates Pllc |
|---|---|
| Speciality | Dentist |
| Location | 1802 Rockingham Ave, Bowling Green, Kentucky |
| Authorized Official Name and Position | Vickie Alvey (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 2707830064 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Kentucky Oral Surgery Associates Pllc 1802 Rockingham Ave Bowling Green KY 42104-3348 Ph: () - | Southern Kentucky Oral Surgery Associates Pllc 1802 Rockingham Ave Bowling Green KY 42104-3348 Ph: (270) 783-0064 |
| NPI Number | 1013104892 |
|---|---|
| Provider Enumeration Date | 09/26/2007 |
| Last Update Date | 09/21/2021 |
| Medicare PECOS PAC ID | 5193776425 |
|---|---|
| Medicare Enrollment ID | O20050203000829 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013104892 | NPI | - | NPPES |
| 7100049450 | Medicaid | KY | |
| 7100049460 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0106X | Dentist - Oral And Maxillofacial Pathology | (* (Not Available)) | Secondary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Jeffrey M Clark |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1649261850 PECOS PAC ID: 0446449862 Enrollment ID: I20110114000721 |
| Provider Name | Michael D Foster |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1962474304 PECOS PAC ID: 7113020652 Enrollment ID: I20151001001208 |
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