Provider Demographics
NPI:1477733749
Name:BALLARD, ANDREW MARTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:MARTIN
Last Name:BALLARD
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 1:8285 SW NIMBUS AVE
Mailing Address - Street 2:SUITE #185
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-6447
Mailing Address - Country:US
Mailing Address - Phone:503-646-1931
Mailing Address - Fax:503-520-1205
Practice Address - Street 1:8285 SW NIMBUS AVE
Practice Address - Street 2:SUITE #185
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-6447
Practice Address - Country:US
Practice Address - Phone:503-646-1931
Practice Address - Fax:503-520-1205
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9824122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist