Provider Demographics
NPI:1366657322
Name:BALLIET, ERIC STEPHEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:STEPHEN
Last Name:BALLIET
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-1441
Mailing Address - Country:US
Mailing Address - Phone:302-856-3374
Mailing Address - Fax:
Practice Address - Street 1:212 W MARKET ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-1441
Practice Address - Country:US
Practice Address - Phone:302-856-3374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEDE0001090122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist