Individual
KIAH BALLANTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2833 LINCOLN ST STE 1, HIGHLAND, IN 46322-1957
(121) 983-8200
Mailing address
2833 LINCOLN ST STE 1, HIGHLAND, IN 46322-1957
(219) 838-2007
(219) 972-5267
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12013029B
IN
Other
Enumeration date
06/22/2018
Last updated
07/29/2021
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