Healthcare Provider Details

I. General information

NPI: 1699803296
Provider Name (Legal Business Name): JAMES W BALLARD, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7181 US HWY. 61 SUITE 10
SAINT FRANCISVILLE LA
70775
US

IV. Provider business mailing address

PO BOX 1068
SAINT FRANCISVILLE LA
70775-1068
US

V. Phone/Fax

Practice location:
  • Phone: 225-635-4707
  • Fax: 225-635-2172
Mailing address:
  • Phone: 225-635-4707
  • Fax: 225-635-2172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number2786
License Number StateLA

VIII. Authorized Official

Name: DR. JAMES WILTON BALLARD
Title or Position: PRES. OF CORPORATION
Credential: DDS
Phone: 225-635-4707