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Contact Information

BLUEGRASS ORAL & MAXILLOFACIAL SURGERY PSC
1401 HARRODSBURG ROAD
SUITE B395
LEXINGTON, KY40504
 Phone: 859-278-5377
 Fax: 859-278-0903
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Oral & Maxillofacial Surgery

204E00000X 02 Physician/General Surgery
 

Oral and Maxillofacial Pathology

1223P0106X
Indicates primary specialty

NPI Profile & details for BLUEGRASS ORAL MAXILLOFACIAL SURGERY PSC · (Female)

NPI Number 1922115625
Status Active
Credentials
Entity Individual
Enumeration date 08/25/2006
Last updated 09/11/2025 - About 9 months ago
Sole proprietor 1 Not specified
Identifiers
  • KY License # 6088
  • Other 61900734 MEDICAID DENTAL
  • Other 65939365 MEDICAL
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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