MEDICARE: DR. RANDALL NEAL BALL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	2490	WV
2	1223P0221X	Pediatric Dentistry	0242	NC

General Provider Information

NPI Number	:	1447237672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDALL NEAL BALL DDS

Provider Business Mailing Address
First Line	:	1 JARRETT WHITE ROAD
Second Line	:	ATTN: MCDS-NH US ARMY DENTAL ACTIVITY HAWAII
City	:	TRIPLER AMC
State	:	HI
Zip	:	96859-5000
Country	:	US
Telephone Number	:	808-433-1021
Fax Number	:	808-433-3928

Provider Business Practice Location Address
First Line	:	1851 MACGREGOR DOWNS RD
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-5925
Country	:	US
Telephone Number	:	252-737-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	05/05/2022

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Directions to “ DR. RANDALL NEAL BALL DDS” Practice Location

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