Provider Demographics
NPI:1003061276
Name:BALLARD, FREDERICK VERNON JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:VERNON
Last Name:BALLARD
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:WEST COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08107-1729
Mailing Address - Country:US
Mailing Address - Phone:856-854-1509
Mailing Address - Fax:
Practice Address - Street 1:501 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:WEST COLLINGSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08107-1729
Practice Address - Country:US
Practice Address - Phone:856-854-1509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI024475001223P0221X
MD14194122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223P0221XDental ProvidersDentistPediatric Dentistry