Healthcare Provider Details

I. General information

NPI: 1104964402
Provider Name (Legal Business Name): BALLDINGER & MILLER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1747 PENNSYLVANIA AVE NW G-100
WASHINGTON DC
20006-4604
US

IV. Provider business mailing address

1747 PENNSYLVANIA AVE NW G-100
WASHINGTON DC
20006-4604
US

V. Phone/Fax

Practice location:
  • Phone: 202-298-6111
  • Fax: 202-526-9456
Mailing address:
  • Phone: 202-298-6111
  • Fax: 202-526-9456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDEN2387
License Number StateDC

VIII. Authorized Official

Name: GARRY MERRILL MILLER
Title or Position: PRESIDENT
Credential: DMD
Phone: 202-298-6111