# MR. ROBERT LEE BALLOU

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1891890679
- **Gender:** Man
- **Credential:** DMD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 3989 | KY | — |
| 1223G0001X | General Practice Dentistry | 3989 | KY | Yes |

## Other

- **Enumeration date:** 09/14/2006
- **Last updated:** 03/10/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4240857 | TENN CARE | TN |
| 05 | — | 60039898 | — | KY |