MEDICARE: DR. TYLER EVAN BALL D.D.S.

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	1223G0001X	General Practice Dentistry	0401414000	VA

General Provider Information

NPI Number	:	1689011066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TYLER EVAN BALL D.D.S.

Provider Business Mailing Address
First Line	:	3120 GROVE AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23221-2810
Country	:	US
Telephone Number	:	276-701-5864
Fax Number	:

Provider Business Practice Location Address
First Line	:	1130 WILKINSON RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-1623
Country	:	US
Telephone Number	:	276-701-5864
Fax Number	:

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

Provider Enumeration Date	:	05/27/2013
Last Update Date	:	05/27/2013

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