MEDICARE: DR. GRACE BALYOUT KERR DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	19329	OH

General Provider Information

NPI Number	:	1134194673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRACE BALYOUT KERR DMD

Provider Business Mailing Address
First Line	:	2752 ERIE AVE
Second Line	:	SUITE 1
City	:	CINCINNATI
State	:	OH
Zip	:	45208-2207
Country	:	US
Telephone Number	:	513-533-4200
Fax Number	:	513-533-4578

Provider Business Practice Location Address
First Line	:	2752 ERIE AVE
Second Line	:	SUITE 1
City	:	CINCINNATI
State	:	OH
Zip	:	45208-2207
Country	:	US
Telephone Number	:	513-533-4200
Fax Number	:	513-533-4578

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2006
Last Update Date	:	07/08/2007

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