Provider Demographics
NPI:1629554639
Name:WURTH ORAL, FACIAL AND COSMETIC SURGERY
Entity Type:Organization
Organization Name:WURTH ORAL, FACIAL AND COSMETIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PLAYFORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-469-1156
Mailing Address - Street 1:1870 OLD LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-9663
Mailing Address - Country:US
Mailing Address - Phone:270-469-1156
Mailing Address - Fax:
Practice Address - Street 1:914 N DIXIE AVE STE 207
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2520
Practice Address - Country:US
Practice Address - Phone:270-737-6969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery