Provider Demographics
NPI:1629259205
Name:BALLRICK, JOHN WALTER (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WALTER
Last Name:BALLRICK
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28885 CENTER RIDGE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5275
Mailing Address - Country:US
Mailing Address - Phone:440-835-6113
Mailing Address - Fax:440-331-8146
Practice Address - Street 1:28885 CENTER RIDGE RD STE 203
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5275
Practice Address - Country:US
Practice Address - Phone:440-835-6113
Practice Address - Fax:440-835-4344
Is Sole Proprietor?:No
Enumeration Date:2007-11-24
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0221561223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics