| Kentucky Center For Oral & Maxillofacial Surgery Psc | |
|
4515 Churchman Ave. Louisville KY 40215 | |
| (502) 361-0134 | |
| (502) 361-0137 |
| Full Name | Kentucky Center For Oral & Maxillofacial Surgery Psc |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 4515 Churchman Ave., Louisville, Kentucky |
| Authorized Official Name and Position | Penny Boone (OFFICE MANAGER) |
| Authorized Official Contact | 5023610134 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kentucky Center For Oral & Maxillofacial Surgery Psc 4515 Churchman Ave. Louisville KY 40215 Ph: (502) 361-0134 | Kentucky Center For Oral & Maxillofacial Surgery Psc 4515 Churchman Ave. Louisville KY 40215 Ph: (502) 361-0134 |
| NPI Number | 1235329400 |
|---|---|
| Provider Enumeration Date | 07/25/2007 |
| Last Update Date | 09/11/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235329400 | NPI | - | NPPES |
| 65941114 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
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