Healthcare Provider Details

I. General information

NPI: 1366676603
Provider Name (Legal Business Name): WILLIAM MICHAEL SEXTON D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 01/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 E HIGH ST
MT STERLING KY
40353-1267
US

IV. Provider business mailing address

25 E HIGH ST
MT STERLING KY
40353-1267
US

V. Phone/Fax

Practice location:
  • Phone: 859-498-6204
  • Fax: 859-498-6205
Mailing address:
  • Phone: 859-498-6204
  • Fax: 859-498-6205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number8728
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number8728
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number48554
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: