Provider Demographics
NPI:1124232632
Name:BALLOU, GAYLA (DDS)
Entity Type:Individual
Prefix:DR
First Name:GAYLA
Middle Name:
Last Name:BALLOU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W BUSINESS 380
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-1645
Mailing Address - Country:US
Mailing Address - Phone:940-626-4442
Mailing Address - Fax:940-626-4485
Practice Address - Street 1:1000 W BUSINESS 380
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-1645
Practice Address - Country:US
Practice Address - Phone:940-626-4442
Practice Address - Fax:940-626-4485
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22730122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist