Provider Demographics
NPI:1952090789
Name:BALES, LONDON (DMD)
Entity type:Individual
Prefix:
First Name:LONDON
Middle Name:
Last Name:BALES
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 1:819 S BUSINESS HIGHWAY 13
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:64067-1515
Mailing Address - Country:US
Mailing Address - Phone:660-667-0303
Mailing Address - Fax:660-251-0524
Practice Address - Street 1:718 HARVEST HILLS DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:MO
Practice Address - Zip Code:64633-2412
Practice Address - Country:US
Practice Address - Phone:877-344-3572
Practice Address - Fax:866-228-4492
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20250196201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice