Provider Demographics
NPI:1205985280
Name:BALLARD, PATRICK F (DMD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:F
Last Name:BALLARD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 MONGER ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36203-1240
Mailing Address - Country:US
Mailing Address - Phone:256-835-4777
Mailing Address - Fax:256-835-4740
Practice Address - Street 1:324 MONGER ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-1240
Practice Address - Country:US
Practice Address - Phone:256-835-4777
Practice Address - Fax:256-835-4740
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5068122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51532061OtherBCBS