Provider Demographics
NPI:1679104657
Name:BALLARD FAMILY DENTISTRY IN BURLESON
Entity Type:Organization
Organization Name:BALLARD FAMILY DENTISTRY IN BURLESON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:TIPPETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-367-6453
Mailing Address - Street 1:2701 SW WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028
Mailing Address - Country:US
Mailing Address - Phone:817-295-2031
Mailing Address - Fax:817-426-2624
Practice Address - Street 1:2701 SW WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028
Practice Address - Country:US
Practice Address - Phone:817-295-2031
Practice Address - Fax:817-426-2624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-29
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty