Provider Demographics
NPI:1518125640
Name:RICHARD A BALLARD DDS PC
Entity Type:Organization
Organization Name:RICHARD A BALLARD DDS PC
Other - Org Name:BALLARD ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-263-4122
Mailing Address - Street 1:301 S DIVISION STREET
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1745
Mailing Address - Country:US
Mailing Address - Phone:208-263-4122
Mailing Address - Fax:208-263-2082
Practice Address - Street 1:301 S DIVISION STREET
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1745
Practice Address - Country:US
Practice Address - Phone:208-263-4122
Practice Address - Fax:208-263-2082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD3867OR261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental