MEDICARE: DR. GEOFFREY S. BALL D.M.D.

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	122300000X	Dentist	KY 7880	KY

General Provider Information

NPI Number	:	1720053614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEOFFREY S. BALL D.M.D.

Provider Business Mailing Address
First Line	:	398 192ND ARMORED TANK BN RD
Second Line	:	US ARMY DENTAL ACTIVITY HEADQUARTERS
City	:	FORT KNOX
State	:	KY
Zip	:	40121-5116
Country	:	US
Telephone Number	:	502-624-6158
Fax Number	:	502-624-2966

Provider Business Practice Location Address
First Line	:	968 1ST INFANTRY DIVISION RD
Second Line	:	BUILDING 2724
City	:	FORT KNOX
State	:	KY
Zip	:	40121
Country	:	US
Telephone Number	:	502-626-8301
Fax Number	:

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	06/24/2016

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