Provider Demographics
NPI:1902040553
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:606-564-9495
Mailing Address - Street 1:399 W MAPLE LEAF RD
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-9176
Mailing Address - Country:US
Mailing Address - Phone:606-564-9495
Mailing Address - Fax:606-564-9495
Practice Address - Street 1:399 W MAPLE LEAF RD
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-9176
Practice Address - Country:US
Practice Address - Phone:606-564-9495
Practice Address - Fax:606-564-9495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
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
KY7100062900Medicaid
000000529364OtherANTHEM
KY7100062920Medicaid
KY7100062920Medicaid