Provider Demographics
NPI:1346344439
Name:BALL, RAYMOND CLYDE JR (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:CLYDE
Last Name:BALL
Suffix:JR
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4358 BRIDGES ST
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-0166
Mailing Address - Country:US
Mailing Address - Phone:252-726-1137
Mailing Address - Fax:
Practice Address - Street 1:4358 BRIDGES ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-0166
Practice Address - Country:US
Practice Address - Phone:252-726-1137
Practice Address - Fax:252-247-3181
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38881223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990382Medicaid
NC90382OtherBLUE CROSS BLUE SHIELD NC
NC8990382Medicaid
NC2428644AMedicare ID - Type Unspecified