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NPI Code Detail

MEDICARE: SCOTT L BALLARD DMD

MEDICARE: SCOTT L BALLARD DMD
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
11223G0001XGeneral Practice Dentistry21307TX

General Provider Information

NPI Number : 1861759268
Entity Type Code : Individual
Provider Name (Legal Business Name) : SCOTT L BALLARD DMD
Provider Business Mailing Address
First Line : 701 W BAILEY BOSWELL RD
Second Line :
City : SAGINAW
State : TX
Zip : 76179-1007
Country : US
Telephone Number : 817-367-6453
Fax Number : 817-847-1194
Provider Business Practice Location Address
First Line : 701 W BAILEY BOSWELL RD
Second Line :
City : SAGINAW
State : TX
Zip : 76179-1007
Country : US
Telephone Number : 817-367-6453
Fax Number : 817-847-1194
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2012
Last Update Date : 04/23/2012

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