Provider Demographics
NPI:1053507400
Name:WILLIAM M BALLANCE DDS
Entity Type:Organization
Organization Name:WILLIAM M BALLANCE DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:BALLANCE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-732-1278
Mailing Address - Street 1:1964 WAKEFIELD STREET
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805
Mailing Address - Country:US
Mailing Address - Phone:804-732-1278
Mailing Address - Fax:
Practice Address - Street 1:1964 WAKEFIELD STREET
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805
Practice Address - Country:US
Practice Address - Phone:804-732-1278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401004200VA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty