Healthcare Provider Details

I. General information

NPI: 1629554639
Provider Name (Legal Business Name): WURTH ORAL, FACIAL AND COSMETIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 N DIXIE AVE STE 207
ELIZABETHTOWN KY
42701-2520
US

IV. Provider business mailing address

1870 OLD LEBANON RD
CAMPBELLSVILLE KY
42718-9663
US

V. Phone/Fax

Practice location:
  • Phone: 270-737-6969
  • Fax:
Mailing address:
  • Phone: 270-469-1156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY PLAYFORTH
Title or Position: OFFICE MANAGER
Credential:
Phone: 270-469-1156