Provider Demographics
NPI:1033298146
Name:BALL, TOM KIRBY (DDS)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:KIRBY
Last Name:BALL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 S BOULEVARD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5155
Mailing Address - Country:US
Mailing Address - Phone:405-348-2641
Mailing Address - Fax:405-348-6388
Practice Address - Street 1:1616 S BOULEVARD ST
Practice Address - Street 2:SUITE A
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5155
Practice Address - Country:US
Practice Address - Phone:405-348-2641
Practice Address - Fax:405-348-6388
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3724122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist