Georgetown Oral and Facial Surgery, LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

7379 Issued in KY

Legal business name

GEORGETOWN ORAL AND FACIAL SURGERY, LLC

Practice address

101 Darby Dr
Suite 101
Georgetown, KY 40324-8715

Phone

(502) 863-5858

Fax

(859) 971-9722

NPI assigned

May 11, 2009

Organization subpart

No

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

Authorized official

Name

Mrs. Amy Cornette Henderson

Title

Office Manager

Phone

(859) 971-9722

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robert W Henderson, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Georgetown, KY
  • NPI 1811915622
  NPD (past)

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

{
    "created_epoch": "1242000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243900800000",
    "number": "1609000272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "972 FIDDLER CREEK WAY",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405156460",
            "telephone_number": "859-971-9722",
            "fax_number": "859-971-9722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 DARBY DR",
            "address_2": "SUITE 101",
            "city": "GEORGETOWN",
            "state": "KY",
            "postal_code": "403248715",
            "telephone_number": "502-863-5858",
            "fax_number": "859-971-9722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGETOWN ORAL AND FACIAL SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-11",
        "last_updated": "2009-06-02",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "CORNETTE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "859-971-9722",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "KY",
            "license": "7379",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1811915622",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Georgetown Ky Pharmacy LLC (Georgetown Pharmacy)
• Georgetown Medical, LLC
• Georgetown Obstetrics and Gynecology P.S.C.
• Georgetown Obstetrics and Gynecology PSC
• Georgetown Open MRI Center
• Georgetown Pediatrics, PSC
• Georgetown Pediatrics, PSC
• Georgetown Sedation Dentistry
• Georgetown Urgent Care PLLC
• Georgetown-Scott County Ambulance Service (Georgetown-Scott County EMS)

• Oral and Maxillofacial Surgery (Dentist) in Georgetown, KY
• Providers in Georgetown, KY by specialty
• Oral and Maxillofacial Surgery (Dentist) in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2009; 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.