NPIMap

Organization Active NPI

Kentucky Center for Oral & Maxillofacial Surgery PSC

  • Oral and Maxillofacial Surgery (Dentist)
  • Richmond, KY
National Provider Identifier
1457379307
Registry record updated Oct 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
KENTUCKY CENTER FOR ORAL & MAXILLOFACIAL SURGERY PSC
Practice address
4097 Atwood Drive
Richmond, KY 40475-2454
Phone
(859) 623-7711
Fax
(859) 624-2611
NPI assigned
Jul 18, 2006
Reactivated
Sep 29, 2022
Last updated
Oct 12, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2022

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

Authorized official

Name
Mrs. Reda S Vaughn
Title
Business Office Manager
Phone
(859) 278-9376

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X KY Primary

Addresses

Primary practice location

4097 Atwood Drive
Richmond, KY 40475-2454

Mailing address

3159 Beaumont Centre Cir Ste 110
Lexington, KY 40513-1968
Phone (859) 278-9376

Other identifiers 1

IdentifierTypeStateIssuer
7100182680MedicaidKY

National Provider Directory

National Provider Directory

Locations

105 Diagnostic Dr
Frankfort, KY 40601
Phone (502) 223-3486

1000 W Main St
Georgetown, KY 40324
Phone (502) 863-2722

2285 Executive Dr
Ste 100
Lexington, KY 40505
Phone (859) 233-1490

2533 Larkin Rd
Ste 101
Lexington, KY 40503
Phone (859) 278-9376

203 Fairfield Dr
Nicholasville, KY 40356
Phone (859) 885-9139

210 Edgewood Dr
Nicholasville, KY 40356
Phone (606) 885-9139

108 Caroline Dr
Pikeville, KY 41501
Phone (606) 432-8863

Practitioners & affiliated clinicians

Practitioners 10

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": "1153180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665532800000",
    "number": "1457379307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3159 BEAUMONT CENTRE CIR STE 110",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405131968",
            "telephone_number": "859-278-9376",
            "fax_number": "859-276-0260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4097 ATWOOD DRIVE",
            "city": "RICHMOND",
            "state": "KY",
            "postal_code": "404752454",
            "telephone_number": "859-623-7711",
            "fax_number": "859-624-2611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENTUCKY CENTER FOR ORAL & MAXILLOFACIAL SURGERY PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-18",
        "last_updated": "2022-10-12",
        "certification_date": "2022-10-12",
        "deactivation_date": "2022-04-11",
        "reactivation_date": "2022-09-29",
        "status": "A",
        "authorized_official_last_name": "VAUGHN",
        "authorized_official_first_name": "REDA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "859-278-9376",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "KY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100182680",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2022; 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.