Provider Demographics
NPI:1083058481
Name:BALE, EMMA (DMD)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:BALE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 B N. CT. ST.
Mailing Address - Street 2:
Mailing Address - City:SCOTTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42164
Mailing Address - Country:US
Mailing Address - Phone:502-794-0135
Mailing Address - Fax:
Practice Address - Street 1:306 B. N. CT. ST.
Practice Address - Street 2:
Practice Address - City:SCOTTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42164
Practice Address - Country:US
Practice Address - Phone:270-237-3521
Practice Address - Fax:843-797-8189
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8194122300000X
KY92121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentist