East Kentucky Oral & Maxillofacial Surgery, PSC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

7103 Issued in KY

Legal business name

EAST KENTUCKY ORAL & MAXILLOFACIAL SURGERY, PSC

Practice address

387 Town Mountain Rd
Pikeville, KY 41501-1640

Phone

(606) 432-5983

Fax

(606) 432-9474

NPI assigned

Aug 12, 2006

Last updated

Aug 22, 2020By 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

Mr. Chad Clifton Street, DMD, MD

Title

Owner

Phone

(606) 432-5983

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962414680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2069",
            "city": "PIKEVILLE",
            "state": "KY",
            "postal_code": "415022069",
            "telephone_number": "606-432-5983",
            "fax_number": "606-432-9474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "387 TOWN MOUNTAIN RD",
            "city": "PIKEVILLE",
            "state": "KY",
            "postal_code": "415011640",
            "telephone_number": "606-432-5983",
            "fax_number": "606-432-9474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST KENTUCKY ORAL & MAXILLOFACIAL SURGERY, PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STREET",
        "authorized_official_first_name": "CHAD",
        "authorized_official_middle_name": "CLIFTON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "606-432-5983",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DMD, MD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "KY",
            "license": "7103",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64068414",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60002300",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• East Kentucky Eye Ear Nose and Thorat Specialists LLC
• East Kentucky Eyecare PLLC
• East Kentucky Medical Associates
• East Kentucky Medical Group PSC
• East Kentucky Medical Group, PSC
• East Ky Pulmonary & Associates
• Jaden Keleigh Easterling, RBT
• Eastern Kentucky Emergency Physicians, LLC
• Eastern Kentucky Kidney Care, PSC
• Eastern Kentucky Treatment

• Oral and Maxillofacial Surgery (Dentist) in Pikeville, KY
• Providers in Pikeville, 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 22, 2020; 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.