GREEN RIVER ORAL SURGERY (NPI# 1750638334) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750638334 |
| Entity Type | Organization |
| Organization Name | GREEN RIVER ORAL SURGERY |
| Practice Address |
801 N Elm St Henderson KY 42420-2705 |
| Practice Telephone | 2702120330 |
| Practice Fax Number | 2702120332 |
| Mailing Telephone | 2702120330 |
| Mailing Fax Number | 2702120332 |
| Enumeration Date | 2012-08-13 |
| Last Update Date | 2012-08-13 |
| Authorized Official Name | DR. ROBERT GENE WAGONER II (OWNER) |
| Authorized Official Telephone | 5708143085 |
| Authorized Official Credential | D.M.D., M.D |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
7298 | KY | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 64063514 | 05 |
| Street Address |
801 N ELM ST |
| City | HENDERSON |
| State | KY |
| Zip Code | 42420-2705 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457408494 | James Cobb Ellis | Dentist | 801 N Elm St, Henderson, KY 42420-2705 | 2007-01-04 |
| 1972138782 | Merre Kay Scott | Dentist | 801 N Elm St, Henderson, KY 42420-2705 | 2020-03-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174136337 | Virtual Consult Md LLC | Psychiatry & Neurology | 2202 Hwy 41 North, Unit E 152, Hendereson, KY 42420 | 2020-08-27 |
| 1679062731 | Maranda Wortham Miles | Nurse Practitioner | 2242 Hwy 41 North, Henderson, KY 42420 | 2018-05-04 |
| 1780124297 | Lisa Lovell | Nurse Practitioner | 230 North Green Street, Henderson, KY 42420 | 2017-03-02 |
| 1437540614 | Kala Hovermale | Social Worker | 220 2nd Street Ste 406, Henderson, KY 42420 | 2015-02-10 |
| 1972991537 | Jessica Thomas | Counselor | 230 Second St, Suite 406, Henderson, KY 42420 | 2015-01-06 |
| 1255690962 | Green River District Health Department | Public Health or Welfare | 631 N. Green Street, Henderson, KY 42420 | 2012-05-15 |
| 1588922769 | Jonathan M Mosley | Family Medicine | 1200 Barrett Blvd, Henderson, KY 42420 | 2012-04-25 |
| 1093099731 | Gregory Ayuk | Pharmacist | 402 Second Street, Henderson, KY 42420 | 2011-09-29 |
| 1437488137 | Peter J. Doll, D.p.m. | Durable Medical Equipment & Medical Supplies | 323 8th St., Henderson, KY 42420 | 2009-12-09 |
| 1760626402 | Linda Dalton Keith | Nurse Practitioner | 1704 2nd St, Henderson, KY 42420 | 2009-04-24 |
| Find all providers in zip 42420 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275902504 | Katherine A. Keeley, Md, PC | Dentist | 2649 Wigwam Pkwy Ste 102, Henderson, NV 89074-7310 | 2015-09-16 |
| 1891942652 | Mahyar Ali Karimi | Dentist | 1701 N Green Valley Pkwy Ste 2e, Henderson, NV 89074-5886 | 2008-08-24 |
| 1093919417 | Bryce D Leavitt | Dentist | 670 S Green Valley Pkwy #15, Henderson, NV 89052 | 2007-06-11 |
| 1740368935 | Robert Gene Wagoner II | Dentist | 801 N. Elm Street, Henderson, KY 42420-2705 | 2006-11-02 |
| 1780794297 | Ryan C Gibson | Dentist | 670 S. Green Valley Pkwy #115, Henderson, NV 89052 | 2006-08-30 |
| 1871820530 | Gibson & Leavitt Oral, Maxillofacial and Implant Surgery Pllc | Dentist | 670 S. Green Valley Pkwy #115, Henderson, NV 89052 | 2009-11-17 |
| 1104079755 | Steve J Huang | Dentist | 1701 N Green Valley Pkwy, Suite 2e, Henderson, NV 89074-5885 | 2008-10-28 |
| 1770607038 | Ronald Albert Moss | Dentist | 451 Ruin Creek Road, Suite 105, Henderson, NC 27536 | 2007-03-19 |
| 1255465092 | George E Bonn | Dentist | 1701 N Green Valley Pkwy, #2e, Henderson, NV 89074 | 2007-03-15 |
| 1710904669 | Dr Ronald A Moss Pa | Dentist | 451 Ruin Creek Road, Suite 105, Henderson, NC 27536 | 2006-07-16 |
| Find all providers in HENDERSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.