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Organization
FRED L BALLOU, DMD, PSC
Active
Organization
FRED L BALLOU, DMD, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FRED L BALLOU JR. DMD (PRESIDENT/OWNER)
(859) 623-3818
Entity
Organization
Contact information
Practice address
311 RADIO PARK DR, STE B, RICHMOND, KY 40475-2399
(859) 623-3818
(859) 624-1061
Mailing address
311 RADIO PARK DR, STE B, RICHMOND, KY 40475-2399
(859) 623-3818
(859) 624-1061
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3905
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
532067
UNITED CONCORDIA
KY
Enumeration date
06/20/2005
Last updated
08/22/2020
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