Healthcare Provider Details

I. General information

NPI: 1013446665
Provider Name (Legal Business Name): JAMIE NICOLE BALL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 05/19/2021
Certification Date: 05/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 NE WINDSOR DR
LEES SUMMIT MO
64086-5594
US

IV. Provider business mailing address

3875 THOMPSON ST
KANSAS CITY KS
66103-3171
US

V. Phone/Fax

Practice location:
  • Phone: 816-554-7668
  • Fax:
Mailing address:
  • Phone: 785-259-5799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2017017883
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: