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General NPI Number Information
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NPI Number | 1558604496
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Entity Type | Individual
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Provider Name | REGINALD BALLARD D.D.S
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Gender | Male
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Dates
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Enumeration Date | 03/28/2013
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Last Update Date | 03/28/2013
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Provider Practice Location Address
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Address Line | 1001 WELCH
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City | TAYLOR
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State | TX
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Zip | 76574-4007
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Country | US
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Telephone | 512-218-3135
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Fax |
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Provider Business Mailing Address
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Address Line | 2630 COLLINGWOOD DR
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City | ROUND ROCK
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State | TX
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Zip | 78665-5620
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Country | US
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Telephone |
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DS030228L
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License Number State | PA
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