Fred L Ballou, DMD, PSC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3905 Issued in KY

Legal business name

FRED L BALLOU, DMD, PSC

Practice address

311 Radio Park Dr
Ste B
Richmond, KY 40475-2399

Phone

(859) 623-3818

Fax

(859) 624-1061

NPI assigned

Jun 20, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Fred L Ballou Jr., DMD

Title

President/Owner

Phone

(859) 623-3818

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1619972205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 RADIO PARK DR",
            "address_2": "STE B",
            "city": "RICHMOND",
            "state": "KY",
            "postal_code": "404752399",
            "telephone_number": "859-623-3818",
            "fax_number": "859-624-1061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 RADIO PARK DR",
            "address_2": "STE B",
            "city": "RICHMOND",
            "state": "KY",
            "postal_code": "404752399",
            "telephone_number": "859-623-3818",
            "fax_number": "859-624-1061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRED L BALLOU, DMD, PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BALLOU",
        "authorized_official_first_name": "FRED",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "859-623-3818",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "3905",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "532067",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Frank McBrayer, M.D. PSC
• Amanda Frate, OTR/L
• Jennifer Darby Frazer, PMHNP-BC
• Deanna Lynn Frazier, AU.D.
• Tamyr Rebecca Frazier, PSY.S.
• Ashley Marie Friend
• Geneva Friend
• Samuel Delbert Fritz, M.D.
• Anna Kay Fry, MS, CCC-SLP
• Eric J. Fuchs, ATC

• General Practice Dentistry in Richmond, KY
• Providers in Richmond, KY by specialty
• General Practice Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.