Provider Demographics
NPI:1205243482
Name:BALL, VICTORIA J (DDS)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:J
Last Name:BALL
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 1:45 SYCAMORE AVE
Mailing Address - Street 2:APT. #1512
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6710
Mailing Address - Country:US
Mailing Address - Phone:304-657-9927
Mailing Address - Fax:
Practice Address - Street 1:45 SYCAMORE AVE
Practice Address - Street 2:APT. #1512
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-6710
Practice Address - Country:US
Practice Address - Phone:304-657-9927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-19
Last Update Date:2014-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC84311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice