Provider Demographics
NPI:1497870034
Name:BALLY, KURT (DMD)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:
Last Name:BALLY
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 1:168 CATANIA WAY
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-4314
Mailing Address - Country:US
Mailing Address - Phone:954-806-6229
Mailing Address - Fax:
Practice Address - Street 1:4050 S US HIGHWAY 1
Practice Address - Street 2:SUITE 322
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-1123
Practice Address - Country:US
Practice Address - Phone:561-691-6055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN176591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice