Provider Demographics
NPI:1679283949
Name:MCNAUGHTON BALLANCE DENTISTRY LLC
Entity Type:Organization
Organization Name:MCNAUGHTON BALLANCE DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HALLIE
Authorized Official - Middle Name:MCNAUGHTON
Authorized Official - Last Name:BALLANCE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-323-4569
Mailing Address - Street 1:929 SW SIMPSON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3599
Mailing Address - Country:US
Mailing Address - Phone:541-323-4569
Mailing Address - Fax:
Practice Address - Street 1:929 SW SIMPSON AVE STE 201
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3599
Practice Address - Country:US
Practice Address - Phone:541-323-4569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental