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 11 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