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General NPI Number Information
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NPI Number | 1548804867
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Entity Type | Organization
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Legal Business Name | BANA BALL DMD LLC
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Dates
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Enumeration Date | 10/30/2019
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Last Update Date | 10/30/2019
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Provider Practice Location Address
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Address Line | 15245 SHADY GROVE RD STE 260
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City | ROCKVILLE
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State | MD
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Zip | 20850-3222
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Country | US
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Telephone | 240-848-7074
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Fax | 240-848-7075
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Provider Business Mailing Address
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Address Line | 15609 WAPELLO WAY
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City | ROCKVILLE
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State | MD
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Zip | 20855-2642
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Country | US
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Telephone | 423-737-8208
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST; OWNER
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Name | DR. BANAFSHEH M BALL
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Credential | DMD
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Telephone | 240-848-7074
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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 |
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License Number State |
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