1. Home
  2. Directory
  3. Kentucky
  4. Henderson
  5. Dentist
  6. NPI Profile

GREEN RIVER ORAL SURGERY
NPI 1750638334
Dentist - Oral and Maxillofacial Surgery in Henderson, KY

Active since August 13, 2012
801 N ELM ST, HENDERSON, KY 42420(270) 212-0330(270) 212-0332 Get Directions Write a Review

NPPES record last updated: August 13, 2012. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Green River Oral Surgery NPPES

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

GREEN RIVER ORAL SURGERY (NPI 1750638334) is a healthcare organization registered as an oral and maxillofacial surgery in Henderson, Kentucky and active in the NPI registry since August 2012. The organization lists Robert Gene Wagoner, Owner, as its authorized official.

NPPES Registry Identity

NPI1750638334
Entity TypeOrganization
Primary Taxonomy1223S0112X
Legal Business NameGREEN RIVER ORAL SURGERY
Location Address801 N ELM STHenderson, KY 42420-2705
Mailing Address801 N Elm StHenderson, KY 42420-2705 · (270) 212-0330 · Fax (270) 212-0332
Phone(270) 212-0330
Fax(270) 212-0332
Organization SubpartNo
Authorized OfficialRobert Gene WagonerOwner · (570) 814-3085
Enumeration DateAugust 13, 2012
✔ NPI 1750638334 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers
Taxonomy Code1223S0112X
License✔ Licensed in KY · 7298
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.
801 N ELM ST, Henderson, KY 42420
Open in Google Maps ↗

Other Identifiers 2

Medicaid64063514KY
Medicare UPINU95876KY

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 SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JAMES COBB ELLIS D.M.D
Dentist (Pediatric Dentistry)
801 N ELM ST
HENDERSON, KY 42420
Henderson County (270) 827-2555

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 Green River Oral Surgery's NPI number?

The NPI number for Green River Oral Surgery is 1750638334. It was assigned to this organization in the NPPES registry on August 13, 2012.

Where is Green River Oral Surgery located?

Green River Oral Surgery is located at 801 N Elm St, Henderson, KY 42420. The listed phone number is (270) 212-0330.

What is Green River Oral Surgery's specialty?

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

When was this NPI record last updated?

The NPPES record for Green River Oral Surgery was last updated on August 13, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.