Organization Name: | KENTUCKY CENTER FOR ORAL & MAXILLOFACIAL SURGERY PSC |
NPI Number: | 1023036480 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | REDA S VAUGHN (OFFICE MANAGER) |
Mailing Address: | 105 Diagnostic Dr Frankfort |
State: | KY US |
Postal Code: | 406016524 |
Phone Number: | 5028754608 |
Fax Number: | 5028750013 |
NPI Enumeration Date: | 07/17/2006 |
NPI Last Update Date: | 01/11/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1223P0221X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Dentist |
Taxonomy Specialization: | Pediatric Dentistry |
Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |