Provider Demographics
NPI:1144593674
Name:MATTHEW M. BALLINGER DDS, LLC
Entity Type:Organization
Organization Name:MATTHEW M. BALLINGER DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIS
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:M
Authorized Official - Last Name:BALLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:443-610-7591
Mailing Address - Street 1:200 ELM ST
Mailing Address - Street 2:LOWER SUITE
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-6551
Mailing Address - Country:US
Mailing Address - Phone:443-610-7591
Mailing Address - Fax:
Practice Address - Street 1:200 ELM ST
Practice Address - Street 2:LOWER SUITE
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6551
Practice Address - Country:US
Practice Address - Phone:443-610-7591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18552641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty