MEDICARE: ORAL SURGERY & IMPLANT 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	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1689304404
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORAL SURGERY & IMPLANT ASSOCIATES

Provider Business Mailing Address
First Line	:	25 E HIGH ST STE 1
Second Line	:
City	:	MT STERLING
State	:	KY
Zip	:	40353-1267
Country	:	US
Telephone Number	:	859-498-6204
Fax Number	:	859-498-6205

Provider Business Practice Location Address
First Line	:	25 E HIGH ST STE 1
Second Line	:
City	:	MT STERLING
State	:	KY
Zip	:	40353-1267
Country	:	US
Telephone Number	:	859-498-6204
Fax Number	:	859-498-6205

Authorized Official
Title or Position	:	OMS
Name	:	WILLIAM MICHAEL SEXTON
Credential	:	DMD, MD
Telephone Number	:	859-744-0677

Provider Enumeration Date	:	06/14/2022
Last Update Date	:	06/17/2022

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