Green River Oral Surgery

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

7298 Issued in KY

Legal business name

GREEN RIVER ORAL SURGERY

Practice address

801 N Elm St
Henderson, KY 42420-2705

Phone

(270) 212-0330

Fax

(270) 212-0332

NPI assigned

Aug 13, 2012

Last updated

Aug 13, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Robert Gene Wagoner II, D.M.D., M.DNPI 1740368935

Title

Owner

Phone

(570) 814-3085

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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.

• Robert Gene Wagoner II, DMD MD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Henderson, KY
  • NPI 1740368935

  Oral and Maxillofacial Surgery

  NPD (past) Authorized official

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

{
    "created_epoch": "1344816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344816000000",
    "number": "1750638334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 N ELM ST",
            "city": "HENDERSON",
            "state": "KY",
            "postal_code": "424202705",
            "telephone_number": "270-212-0330",
            "fax_number": "270-212-0332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 N ELM ST",
            "city": "HENDERSON",
            "state": "KY",
            "postal_code": "424202705",
            "telephone_number": "270-212-0330",
            "fax_number": "270-212-0332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN RIVER ORAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-13",
        "last_updated": "2012-08-13",
        "status": "A",
        "authorized_official_last_name": "WAGONER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "GENE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "570-814-3085",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "D.M.D., M.D"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "KY",
            "license": "7298",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64063514",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Traci Goodman
• Terrye Gower, RPH
• Kendra M Gray, PH.D.
• Rhiannon M. Gray, MA ME.D LPCA
• Green River District Health Dept (Henderson County Health Center)
• Michael Joel Greene, DC
• Kathryn Dru Greenwell Perkins, APRN
• Chelsey C. Gregory, DMD
• Justin Matthew Greubel, PHARMD
• Dawson Gross

• Oral and Maxillofacial Surgery (Dentist) in Henderson, KY
• Providers in Henderson, 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 Aug 13, 2012; 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.