| NPI | 1619972205 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRED L BALLOU President/Owner 859-623-3818 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 3905) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2020-08-22 |