Provider Demographics
NPI:1063514792
Name:FAULKNER, WILLIAM BALLARD III (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BALLARD
Last Name:FAULKNER
Suffix:III
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 1:210 E PIKE ST
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-1554
Mailing Address - Country:US
Mailing Address - Phone:859-234-1465
Mailing Address - Fax:859-234-1565
Practice Address - Street 1:210 E PIKE ST
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-1554
Practice Address - Country:US
Practice Address - Phone:859-234-1465
Practice Address - Fax:859-234-1565
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY50681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice