# SHELDON A. BALLOU, DMD, PSC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063564813
- **Authorized official:** DR. SHELDON ARCH BALLOU DMD (PRESIDENT)
- **Authorized official phone:** (270) 773-3943

## Contact information

- **Practice address:** 203 S DIXIE HWY, CAVE CITY, KY 42127-8866
- **Practice address phone:** (270) 773-3943
- **Practice address fax:** (270) 773-3944
- **Mailing address:** 203 S DIXIE HWY, CAVE CITY, KY 42127-8866
- **Mailing address phone:** (270) 773-3943
- **Mailing address fax:** (270) 773-3944

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 6425 | KY | Yes |

## Other

- **Enumeration date:** 01/18/2007
- **Last updated:** 05/12/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 60064250 | — | KY |