Provider Demographics
NPI:1720140429
Name:EDWARD J BALLING D M D & ASSOCIATES
Entity Type:Organization
Organization Name:EDWARD J BALLING D M D & ASSOCIATES
Other - Org Name:STRATFORD DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BALLING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-783-0303
Mailing Address - Street 1:62 WARWICK RD
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08084-1729
Mailing Address - Country:US
Mailing Address - Phone:856-783-0303
Mailing Address - Fax:856-783-0502
Practice Address - Street 1:62 WARWICK RD
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1729
Practice Address - Country:US
Practice Address - Phone:856-783-0303
Practice Address - Fax:856-783-0502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-16
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI018505001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty