NPIMap

Organization Active NPI

Kentucky Center for Oral & Maxillofacial Surgery

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Richmond, KY
National Provider Identifier
1740323633
Registry record updated Sep 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
Legal business name
KENTUCKY CENTER FOR ORAL & MAXILLOFACIAL SURGERY
Practice address
4097 Atwood Drive
Richmond, KY 40475-2454
Phone
(859) 623-7711
Fax
(859) 624-2611
NPI assigned
Feb 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2022

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral & Maxillofacial Surgery (D.M.D.)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 204E00000X Primary

Addresses

Primary practice location

4097 Atwood Drive
Richmond, KY 40475-2454

Mailing address

3159 Beaumont Centre Circle
Suite 110
Lexington, KY 40513-1934
Phone (859) 278-9376

Other identifiers 1

IdentifierTypeStateIssuer
7100182700MedicaidKY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664409600000",
    "number": "1740323633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3159 BEAUMONT CENTRE CIRCLE",
            "address_2": "SUITE 110",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405131934",
            "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",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2022-09-29",
        "certification_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": "OFFICE MANAGER",
        "authorized_official_telephone_number": "859-278-9376",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100182700",
            "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 Sep 29, 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.