Healthcare Provider Details

I. General information

NPI: 1447237672
Provider Name (Legal Business Name): RANDALL NEAL BALL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 MACGREGOR DOWNS RD
GREENVILLE NC
27834-5925
US

IV. Provider business mailing address

1 JARRETT WHITE ROAD ATTN: MCDS-NH US ARMY DENTAL ACTIVITY HAWAII
TRIPLER AMC HI
96859-5000
US

V. Phone/Fax

Practice location:
  • Phone: 252-737-7000
  • Fax:
Mailing address:
  • Phone: 808-433-1021
  • Fax: 808-433-3928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2490
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0242
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: