Organization Active NPI

Elizabethtown Oral and Maxillofacial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Elizabethtown, KY
National Provider Identifier
1407753734
Registry record updated Oct 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
ELIZABETHTOWN ORAL AND MAXILLOFACIAL SURGERY
Practice address
914 N Dixie Ave Ste 207
Elizabethtown, KY 42701-2520
Phone
(270) 737-6969
Fax
(502) 897-0427
NPI assigned
Oct 21, 2026
Last updated
Oct 21, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Shelbie Hearn
Title
Office Manager
Phone
(502) 442-9966

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X Primary
Oral & Maxillofacial Surgery (D.M.D.)Group: 193200000X MULTI-SPECIALTY GROUP 204E00000X

Addresses

Primary practice location

914 N Dixie Ave Ste 207
Elizabethtown, KY 42701-2520

Mailing address

914 N Dixie Ave Ste 207
Elizabethtown, KY 42701-2520
Phone (270) 737-6969

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1792540800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792540800000",
    "number": "1407753734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "914 N DIXIE AVE STE 207",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427012520",
            "telephone_number": "270-737-6969",
            "fax_number": "502-897-0427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "914 N DIXIE AVE STE 207",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427012520",
            "telephone_number": "270-737-6969",
            "fax_number": "502-897-0427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELIZABETHTOWN ORAL AND MAXILLOFACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-10-21",
        "last_updated": "2026-10-21",
        "certification_date": "2026-10-21",
        "status": "A",
        "authorized_official_last_name": "HEARN",
        "authorized_official_first_name": "SHELBIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "502-442-9966",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabethtown, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.