Healthcare Provider Details

I. General information

NPI: 1114915576
Provider Name (Legal Business Name): MR. RAY BALL
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CAPEHART RD
OFFUTT A F B NE
68113-1043
US

IV. Provider business mailing address

12443 SOUTH 35TH STREET
BELLEVUE NE
68123
US

V. Phone/Fax

Practice location:
  • Phone: 402-232-9137
  • Fax:
Mailing address:
  • Phone: 402-292-1480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: