Provider Demographics
NPI:1356691745
Name:BALL, AMANDA AHMED (DMD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:AHMED
Last Name:BALL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 S KOOLS ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-3932
Mailing Address - Country:US
Mailing Address - Phone:920-996-0123
Mailing Address - Fax:
Practice Address - Street 1:381 S KOOLS ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-3932
Practice Address - Country:US
Practice Address - Phone:920-996-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI69681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice