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NPI Code Detail

MEDICARE: DR. DAVID BALLARD DDS

MEDICARE: DR. DAVID BALLARD 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
1122300000XDentist21511TX

General Provider Information

NPI Number : 1316086564
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID BALLARD DDS
Provider Business Mailing Address
First Line : 701 W BAILEY BOSWELL RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76179-1007
Country : US
Telephone Number : 817-367-6453
Fax Number :
Provider Business Practice Location Address
First Line : 701 W BAILEY BOSWELL RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76179-1007
Country : US
Telephone Number : 817-367-6453
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2007
Last Update Date : 09/12/2007

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