Provider Demographics
NPI:1073523379
Name:BALLRICK ORTHODONTICS, INC.
Entity Type:Organization
Organization Name:BALLRICK ORTHODONTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:BALLRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-331-5450
Mailing Address - Street 1:28885 CENTER RIDGE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5275
Mailing Address - Country:US
Mailing Address - Phone:440-835-6113
Mailing Address - Fax:440-331-8146
Practice Address - Street 1:28885 CENTER RIDGE RD STE 203
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5275
Practice Address - Country:US
Practice Address - Phone:440-835-6113
Practice Address - Fax:440-331-8146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0221561223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty