MEDICARE: HOLLY BALLER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	00202893	CO

General Provider Information

NPI Number	:	1033561642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY BALLER DDS

Provider Business Mailing Address
First Line	:	7583 S GRAND BAKER CT
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80016-2583
Country	:	US
Telephone Number	:	720-252-3452
Fax Number	:

Provider Business Practice Location Address
First Line	:	9400 STATION ST
Second Line	:
City	:	LONE TREE
State	:	CO
Zip	:	80124-6808
Country	:	US
Telephone Number	:	303-690-0400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2016
Last Update Date	:	07/07/2016

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Directions to “ HOLLY BALLER DDS” Practice Location

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