Kentuckiana Oral & Maxillofacial Surgery Assoc PSC
NPI 1396737011ActiveOrganization· Dentist, Oral and Maxillofacial Surgery· Louisville, KY
Dentist, Oral and Maxillofacial Surgery in Louisville, Kentucky, registered in NPPES in August 2005. The authorized official on file is Nathan F. Walters, DMD, President. Enrolled in Medicare as part b supplier - clinic/group practice and part b supplier - clinic/group practice.
Overview
| NPI | 1396737011 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Aug 18, 2005 |
| Last updated in NPPES | Feb 6, 2018 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist, Oral and Maxillofacial Surgery Primary | 1223S0112X | — | KY |
| Dentist | 122300000X | — | KY |
| Oral & Maxillofacial Surgery | 204E00000X | — | KY |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (IN); Part B Supplier - Clinic/Group Practice (KY) |
|---|
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