OrganizationBluegrass Oral & Maxillofacial Surgery PscDentistDental ProvidersPractice Address1401 Harrodsburg Road, Suite B395, Lexington, KY 40504(859) 278-5377PECOS EnrollmentBased on the most recent information from CMS, provider Bluegrass Oral & Maxillofacial Surgery Psc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1922115625Provider TypeOrganizationFull NameBluegrass Oral & Maxillofacial Surgery PscSubpartNoEnumeration Date8/25/2006Last Updated8/22/2020Contact InformationPractice LocationPractice Address1401 Harrodsburg Road, Suite B395, Lexington, KY 40504Phone(859) 278-5377Fax(859) 278-0903Mailing LocationMailing Address1401 Harrodsburg Road, Suite B395, Lexington, KY 40504Phone(859) 278-5377Fax(859) 278-0903Authorized OfficialNameBarker, William J (President)Phone(859) 278-5377Provider TaxonomiesCodeDescriptionLicenseCode1223P0106XDescriptionDentistDental ProvidersLicense6088KentuckyCode204E00000XDescriptionOral & Maxillofacial SurgeryAllopathic & Osteopathic PhysiciansLicense6088KentuckyProvider IdentifiersIDDescriptionIssuerID65939365DescriptionOtherIssuerMEDICALID61900734DescriptionOtherIssuerMEDICAID DENTAL