Healthcare Provider Details

I. General information

NPI: 1093588964
Provider Name (Legal Business Name): BALLRICK AND PETTS ORTHODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28885 CENTER RIDGE RD STE 203
WESTLAKE OH
44145-5275
US

IV. Provider business mailing address

28885 CENTER RIDGE RD STE 203
WESTLAKE OH
44145-5275
US

V. Phone/Fax

Practice location:
  • Phone: 440-835-6113
  • Fax:
Mailing address:
  • Phone: 440-835-6113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JOHN WALTER BALLRICK
Title or Position: PARTNER
Credential: DDS, MSD
Phone: 440-331-5450