KENTUCKIANA ORAL & MAXILLOFACIAL SURGERY ASSOC PSC
NPI 1396737011
Dentist - Oral and Maxillofacial Surgery in Louisville, KY

Q: What is Kentuckiana Oral & Maxillofacial Surgery Assoc Psc's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Active since August 18, 2005

2800 CANNONS LN, STE 200, LOUISVILLE, KY 40205(502) 454-4885(502) 452-1926 Get Directions Write a Review

NPPES record last updated: February 6, 2018. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About Kentuckiana Oral & Maxillofacial Surgery Assoc Psc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENTUCKIANA ORAL & MAXILLOFACIAL SURGERY ASSOC PSC (NPI 1396737011) is a healthcare organization registered as an oral and maxillofacial surgery in Louisville, Kentucky and active in the NPI registry since August 2005. The organization lists Nathan F Walters, President, as its authorized official.

NPPES Registry Identity

NPI1396737011

Entity TypeOrganization

Primary Taxonomy1223S0112X

Legal Business NameKENTUCKIANA ORAL & MAXILLOFACIAL SURGERY ASSOC PSC

Location Address2800 CANNONS LN, STE 200Louisville, KY 40205

Mailing Address2800 Cannons Ln, Ste 200Louisville, KY 40205 · (502) 454-4885 · Fax (502) 452-1926

Phone(502) 454-4885

Fax(502) 452-1926

Organization SubpartNo

Authorized OfficialNathan F WaltersPresident · (502) 454-4885

Enumeration DateAugust 18, 2005

Last NPPES UpdateFebruary 6, 2018

✔ NPI 1396737011 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers

Taxonomy Code1223S0112X

Definition

An oral and maxillofacial surgery dentist specialized in 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.

Also ListedDentistTaxonomy 122300000X

Also ListedOral & Maxillofacial SurgeryTaxonomy 204E00000X

2800 CANNONS LN, Louisville, KY 40205

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Other Identifiers 5

Medicaid7100224860KY

OtherDC1281KY · Railroad Medicare

Medicaid7100232940KY

Medicaid7100231360KY

Other50004012KY · Passport Group

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter Health, Ambetter of Tennessee and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kentuckiana Oral & Maxillofacial Surgery Assoc Psc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 4 clinicians reassign Medicare billing to Kentuckiana Oral & Maxillofacial Surgery Assoc Psc, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 4 within 10 miles. They are listed nearest first.

Clinicians, nearest first (4)

Nathan Walters, DMD

Maxillofacial Surgery

NPI 1265424907

2800 CANNONS LN STE 200
Louisville, KY 40205

(502) 454-4885

✔ PECOSSame address

Jamie Warren, DMD, MD

Maxillofacial Surgery

NPI 1437291655

2800 CANNONS LN STE 200
Louisville, KY 40205

(502) 454-4885

✔ PECOSSame address

Geoffrey Mills, M.D.

Maxillofacial Surgery

NPI 1760521850

225 ABRAHAM FLEXNER WAY SUITE 302
Louisville, KY 40202

(502) 587-7874

✔ PECOS✔ Accepts Medicare5.6 mi

Christopher Noonan, DMD MD

Maxillofacial Surgery

NPI 1700879095

225 ABRAHAM FLEXNER WAY STE 302
Louisville, KY 40202

(502) 587-7874

✔ PECOS✔ Accepts Medicare5.6 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kentuckiana Oral & Maxillofacial Surgery Assoc Psc's NPI number?

The NPI number for Kentuckiana Oral & Maxillofacial Surgery Assoc Psc is 1396737011. It was assigned to this organization in the NPPES registry on August 18, 2005.

Where is Kentuckiana Oral & Maxillofacial Surgery Assoc Psc located?

Kentuckiana Oral & Maxillofacial Surgery Assoc Psc is located at 2800 Cannons Ln Ste 200, Louisville, KY 40205. The listed phone number is (502) 454-4885.

What is Kentuckiana Oral & Maxillofacial Surgery Assoc Psc's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Is Kentuckiana Oral & Maxillofacial Surgery Assoc Psc enrolled in Medicare?

Yes. Kentuckiana Oral & Maxillofacial Surgery Assoc Psc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Kentuckiana Oral & Maxillofacial Surgery Assoc Psc?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians, all in Maxillofacial Surgery, reassign their Medicare billing to Kentuckiana Oral & Maxillofacial Surgery Assoc Psc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice at this address and 4 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Kentuckiana Oral & Maxillofacial Surgery Assoc Psc accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter of Tennessee, DentaQuest USA Insurance and UnitedHealthcare list Kentuckiana Oral & Maxillofacial Surgery Assoc Psc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kentuckiana Oral & Maxillofacial Surgery Assoc Psc was last updated on February 6, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.