Provider Demographics
NPI:1205183613
Name:BALL, ANDREA LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:LYNN
Last Name:BALL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:LYNN
Other - Last Name:WILDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:7248 RIVER GLEN DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2746
Mailing Address - Country:US
Mailing Address - Phone:606-344-4444
Mailing Address - Fax:317-257-5909
Practice Address - Street 1:6117 N COLLEGE AVE STE 1&2
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2233
Practice Address - Country:US
Practice Address - Phone:317-257-3368
Practice Address - Fax:317-257-5909
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011857A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice