Provider Demographics
NPI:1376192690
Name:LAUREN BALLARD DMD, PC
Entity Type:Organization
Organization Name:LAUREN BALLARD DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:267-742-7709
Mailing Address - Street 1:2112 33RD ST APT 1C
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2399
Mailing Address - Country:US
Mailing Address - Phone:267-742-7709
Mailing Address - Fax:
Practice Address - Street 1:6053 FRESH POND RD
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-3541
Practice Address - Country:US
Practice Address - Phone:267-742-7709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty