Provider Demographics
NPI:1730308776
Name:BALLIS, STEVE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:
Last Name:BALLIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 W EVERETT RD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-2697
Mailing Address - Country:US
Mailing Address - Phone:847-457-9200
Mailing Address - Fax:847-457-9201
Practice Address - Street 1:123 S NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4243
Practice Address - Country:US
Practice Address - Phone:847-823-6600
Practice Address - Fax:847-823-6606
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0208311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364062517OtherTIN