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General NPI Number Information
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NPI Number | 1477993756
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Entity Type | Individual
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Provider Name | ANDRE LAMAR BALLARD D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/01/2013
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 885 DAWSONVILLE HWY STE 1130
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City | GAINESVILLE
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State | GA
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Zip | 30501-2641
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Country | US
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Telephone | 678-696-8878
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Fax | 678-696-8879
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Provider Business Mailing Address
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Address Line | 885 DAWSONVILLE HWY STE 1130
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City | GAINESVILLE
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State | GA
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Zip | 30501-2641
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Country | US
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Telephone | 678-696-8878
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Fax | 678-696-8879
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN014841
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License Number State | GA
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