Healthcare Provider Details

I. General information

NPI: 1295914471
Provider Name (Legal Business Name): ORAL & FACIAL SURGERY CENTER OF KY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 MARY T MEAGHER RD
ELIZABETHTOWN KY
42701-7990
US

IV. Provider business mailing address

1105 MARY T MEAGHER RD
ELIZABETHTOWN KY
42701-7990
US

V. Phone/Fax

Practice location:
  • Phone: 270-737-0586
  • Fax: 270-737-2949
Mailing address:
  • Phone: 270-737-0586
  • Fax: 270-737-2949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number35220
License Number StateKY

VIII. Authorized Official

Name: DR. JAMES KEVIN HARGAN
Title or Position: DOCTOR / OWNER
Credential: D.M.D., M.D.
Phone: 270-737-0586