Provider Demographics
NPI:1205289352
Name:MARC L. BALL DDS, PS
Entity type:Organization
Organization Name:MARC L. BALL DDS, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:TROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-662-9685
Mailing Address - Street 1:620 N EMERSON AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-6619
Mailing Address - Country:US
Mailing Address - Phone:509-662-9685
Mailing Address - Fax:
Practice Address - Street 1:620 N EMERSON AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-6619
Practice Address - Country:US
Practice Address - Phone:509-662-9685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5215122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6729430001OtherMEDICARE PTAN