Provider Demographics
NPI:1093909012
Name:BALL, HEATHER MARGURITE (RDH)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MARGURITE
Last Name:BALL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 CHARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:POPLARVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39470-6305
Mailing Address - Country:US
Mailing Address - Phone:601-463-0181
Mailing Address - Fax:
Practice Address - Street 1:1718 S MAIN ST
Practice Address - Street 2:
Practice Address - City:POPLARVILLE
Practice Address - State:MS
Practice Address - Zip Code:39470-4287
Practice Address - Country:US
Practice Address - Phone:601-795-8024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-03
Last Update Date:2007-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3409-04DH124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist