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General NPI Number Information
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NPI Number | 1528381357
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Entity Type | Individual
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Provider Name | MARY L BALLARD DDS
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Gender | Female
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Dates
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Enumeration Date | 03/08/2010
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 13200 GLOBE DR STE 108
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City | MT PLEASANT
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State | WI
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Zip | 53177-1606
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Country | US
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Telephone | 262-886-0147
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Fax | 262-886-0570
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Provider Business Mailing Address
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Address Line | 13200 GLOBE DR STE 108
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City | MT PLEASANT
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State | WI
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Zip | 53177-1606
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Country | US
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Telephone | 262-886-0147
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Fax | 262-886-0570
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 7206-15
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License Number State | WI
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