Healthcare Provider Details

I. General information

NPI: 1689304404
Provider Name (Legal Business Name): ORAL SURGERY & IMPLANT ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 E HIGH ST STE 1
MT STERLING KY
40353-1267
US

IV. Provider business mailing address

25 E HIGH ST STE 1
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 Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM MICHAEL SEXTON
Title or Position: OMS
Credential: DMD, MD
Phone: 859-744-0677