Individual
DR. GEORGE ROBERT BALLEW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
110 N 1ST ST, BROKEN ARROW, OK 74012-3945
(918) 258-1547
Mailing address
110 N 1ST ST, BROKEN ARROW, OK 74012-3945
(918) 258-1547
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4805
OK
Other
Enumeration date
02/07/2007
Last updated
07/08/2007
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