Provider Demographics
NPI:1164442976
Name:KALB, KENT WALTON (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:WALTON
Last Name:KALB
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 ELIZAVILLE AVE
Mailing Address - Street 2:PO BOX 448
Mailing Address - City:FLEMINGSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41041-9208
Mailing Address - Country:US
Mailing Address - Phone:606-845-3010
Mailing Address - Fax:606-849-4004
Practice Address - Street 1:813 ELIZAVILLE AVE
Practice Address - Street 2:
Practice Address - City:FLEMINGSBURG
Practice Address - State:KY
Practice Address - Zip Code:41041-9208
Practice Address - Country:US
Practice Address - Phone:606-845-3010
Practice Address - Fax:606-849-4004
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY62661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice