Provider Demographics
NPI:1003845538
Name:BALLINGER, CHRISTOPHER N (DMD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:N
Last Name:BALLINGER
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 1:705 COLISEUM DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-5312
Mailing Address - Country:US
Mailing Address - Phone:336-721-7921
Mailing Address - Fax:336-721-7926
Practice Address - Street 1:705 COLISEUM DR
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-5312
Practice Address - Country:US
Practice Address - Phone:336-721-7921
Practice Address - Fax:336-721-7926
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC74031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC017U2OtherBCBSNC
NC89902H1Medicaid