Provider Demographics
NPI:1477993756
Name:BALLARD, ANDRE LAMAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:LAMAR
Last Name:BALLARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:885 DAWSONVILLE HWY STE 1130
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2641
Mailing Address - Country:US
Mailing Address - Phone:678-696-8878
Mailing Address - Fax:678-696-8879
Practice Address - Street 1:885 DAWSONVILLE HWY STE 1130
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2641
Practice Address - Country:US
Practice Address - Phone:678-696-8878
Practice Address - Fax:678-696-8879
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0148411223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry