Provider Demographics
NPI:1548804867
Name:BANA BALL DMD LLC
Entity Type:Organization
Organization Name:BANA BALL DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST; OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BANAFSHEH
Authorized Official - Middle Name:M
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:240-848-7074
Mailing Address - Street 1:15609 WAPELLO WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20855-2642
Mailing Address - Country:US
Mailing Address - Phone:423-737-8208
Mailing Address - Fax:
Practice Address - Street 1:15245 SHADY GROVE RD STE 260
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3222
Practice Address - Country:US
Practice Address - Phone:240-848-7074
Practice Address - Fax:240-848-7075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty