Provider Demographics
NPI:1639186984
Name:BALLENGER, DAN L (DDS, PA)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:L
Last Name:BALLENGER
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3896
Mailing Address - Country:US
Mailing Address - Phone:501-227-7999
Mailing Address - Fax:501-227-9547
Practice Address - Street 1:12 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3896
Practice Address - Country:US
Practice Address - Phone:501-227-7999
Practice Address - Fax:501-227-9547
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR25201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR831313OtherUNITED CONCORDIA
AR58597OtherARKANSAS BLUE CROSS