Provider Demographics
NPI:1134383631
Name:BALLEW, CHRIS A (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:A
Last Name:BALLEW
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 1:1501 N ARIZONA BLVD
Mailing Address - Street 2:
Mailing Address - City:COOLIDGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85128-3215
Mailing Address - Country:US
Mailing Address - Phone:520-723-1700
Mailing Address - Fax:520-340-7800
Practice Address - Street 1:1501 N ARIZONA BLVD
Practice Address - Street 2:
Practice Address - City:COOLIDGE
Practice Address - State:AZ
Practice Address - Zip Code:85128-3215
Practice Address - Country:US
Practice Address - Phone:520-723-1700
Practice Address - Fax:520-340-7800
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7579122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7579OtherARIZONA LICENSE