MEDICARE: SOUTHEAST ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	6468	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629180252
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES

Provider Business Mailing Address
First Line	:	1400 CUMBERLAND FALLS HWY
Second Line	:	SUITE B
City	:	CORBIN
State	:	KY
Zip	:	40701-2739
Country	:	US
Telephone Number	:	606-528-9402
Fax Number	:	606-528-9402

Provider Business Practice Location Address
First Line	:	1400 CUMBERLAND FALLS HWY
Second Line	:	SUITE B
City	:	CORBIN
State	:	KY
Zip	:	40701-2739
Country	:	US
Telephone Number	:	606-528-9402
Fax Number	:	606-528-9402

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL TIMOTHY MURPHY
Credential	:	DMD
Telephone Number	:	606-528-9402

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/22/2020

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Directions to “SOUTHEAST ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES ” Practice Location

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