Provider Demographics
NPI:1548397904
Name:ROBIN C BALLARD DDS PC
Entity Type:Organization
Organization Name:ROBIN C BALLARD DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-639-2079
Mailing Address - Street 1:BOX 3026
Mailing Address - Street 2:226 W STATE ST
Mailing Address - City:MONTROSE
Mailing Address - State:MI
Mailing Address - Zip Code:48457
Mailing Address - Country:US
Mailing Address - Phone:810-639-2079
Mailing Address - Fax:810-639-6893
Practice Address - Street 1:226 W STATE ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:MI
Practice Address - Zip Code:48457
Practice Address - Country:US
Practice Address - Phone:810-639-2079
Practice Address - Fax:810-639-6893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI013123122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty