Provider Demographics
NPI:1508023821
Name:BALLARD C SMITH PLLC
Entity Type:Organization
Organization Name:BALLARD C SMITH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BALLARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-784-8983
Mailing Address - Street 1:709 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1443
Mailing Address - Country:US
Mailing Address - Phone:606-784-8983
Mailing Address - Fax:606-784-4408
Practice Address - Street 1:709 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1443
Practice Address - Country:US
Practice Address - Phone:606-784-8983
Practice Address - Fax:606-784-4408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100013150Medicaid
KY7100062910Medicaid
KY7100010590Medicaid
KY7100062890Medicaid
KY000000529364OtherANTHEM
KY7100010590Medicaid