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General NPI Number Information
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NPI Number | 1578459756
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Entity Type | Individual
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Provider Name | JACQUELINE C BALLAY DDS
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Gender | Female
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Dates
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Enumeration Date | 06/16/2025
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 2515 IOWA ST
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City | LAWRENCE
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State | KS
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Zip | 66046-4042
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Country | US
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Telephone | 785-588-4422
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Fax |
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Provider Business Mailing Address
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Address Line | 9220 BOEHM DR
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City | LENEXA
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State | KS
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Zip | 66219-2198
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Country | US
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Telephone | 417-772-6160
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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 | 62352
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License Number State | KS
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