Individual
MR. ROBERT LEE BALLOU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
109 N MAIN ST, CORBIN, KY 40701
(606) 528-2350
(606) 528-5507
Mailing address
109 N MAIN ST, CORBIN, KY 40701
(606) 528-2350
(606) 528-5507
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
3989
KY
1223G0001X
General Practice Dentistry
Primary
3989
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4240857
TENN CARE
TN
05
—
60039898
—
KY
Enumeration date
09/14/2006
Last updated
03/10/2008
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