Provider Demographics
NPI:1720394794
Name:BALL, BANAFSHEH M (DMD)
Entity Type:Individual
Prefix:DR
First Name:BANAFSHEH
Middle Name:M
Last Name:BALL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15245 SHADY GROVE RD STE 260
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3222
Mailing Address - Country:US
Mailing Address - Phone:240-848-7074
Mailing Address - Fax:240-848-7075
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
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD146761223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty