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General NPI Number Information
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NPI Number | 1922115625
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Entity Type | Organization
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Legal Business Name | BLUEGRASS ORAL & MAXILLOFACIAL SURGERY PSC
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1401 HARRODSBURG ROAD SUITE B395
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City | LEXINGTON
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State | KY
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Zip | 40504
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Country | US
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Telephone | 859-278-5377
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Fax | 859-278-0903
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Provider Business Mailing Address
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Address Line | 1401 HARRODSBURG ROAD SUITE B395
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City | LEXINGTON
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State | KY
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Zip | 40504
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Country | US
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Telephone | 859-278-5377
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Fax | 859-278-0903
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM J BARKER
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Credential | DMD
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Telephone | 859-278-5377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number | 6088
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 6088
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License Number State | KY
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