Provider Demographics
NPI:1811028053
Name:MILLER BALLARD, JENNIFER R (DDS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:MILLER BALLARD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 ARTHUR ST STE 5
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-6665
Mailing Address - Country:US
Mailing Address - Phone:319-337-2114
Mailing Address - Fax:319-337-3382
Practice Address - Street 1:1039 ARTHUR ST STE 5
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-6665
Practice Address - Country:US
Practice Address - Phone:319-337-2114
Practice Address - Fax:319-337-3382
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA78331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice