Provider Demographics
NPI:1770605388
Name:BALLINGER, MARK E (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:BALLINGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20 E TIMONIUM RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3400
Mailing Address - Country:US
Mailing Address - Phone:410-252-3717
Mailing Address - Fax:410-252-3482
Practice Address - Street 1:20 E TIMONIUM RD
Practice Address - Street 2:SUITE 300
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-3400
Practice Address - Country:US
Practice Address - Phone:410-252-3717
Practice Address - Fax:410-252-3482
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD70021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice