Healthcare Provider Details

I. General information

NPI: 1508023821
Provider Name (Legal Business Name): BALLARD C SMITH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 04/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 W MAIN ST
MOREHEAD KY
40351-1443
US

IV. Provider business mailing address

709 W MAIN ST
MOREHEAD KY
40351-1443
US

V. Phone/Fax

Practice location:
  • Phone: 606-784-8983
  • Fax: 606-784-4408
Mailing address:
  • Phone: 606-784-8983
  • Fax: 606-784-4408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: BALLARD C SMITH
Title or Position: OWNER
Credential: DMD
Phone: 606-784-8983