Provider Demographics
NPI:1144669672
Name:DR. DAN BALLENGER
Entity type:Organization
Organization Name:DR. DAN BALLENGER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BALLENGER
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:501-227-7999
Mailing Address - Street 1:12 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3896
Mailing Address - Country:US
Mailing Address - Phone:501-227-7999
Mailing Address - Fax:501-227-9547
Practice Address - Street 1:12 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3896
Practice Address - Country:US
Practice Address - Phone:501-227-7999
Practice Address - Fax:501-227-9547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty