| Fred L Ballou, Dmd, Psc | |
|
311 Radio Park Dr Ste B Richmond KY 40475-2399 | |
| (859) 623-3818 | |
| (859) 624-1061 |
| Full Name | Fred L Ballou, Dmd, Psc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 311 Radio Park Dr, Richmond, Kentucky |
| Authorized Official Name and Position | Fred L Ballou (PRESIDENT/OWNER) |
| Authorized Official Contact | 8596233818 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fred L Ballou, Dmd, Psc 311 Radio Park Dr Ste B Richmond KY 40475-2399 Ph: (859) 623-3818 | Fred L Ballou, Dmd, Psc 311 Radio Park Dr Ste B Richmond KY 40475-2399 Ph: (859) 623-3818 |
| NPI Number | 1619972205 |
|---|---|
| Provider Enumeration Date | 06/20/2005 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619972205 | NPI | - | NPPES |
| 532067 | Other | KY | UNITED CONCORDIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 3905 (Kentucky) | Primary |
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