Provider Demographics
NPI:1538176359
Name:BALLARD, CHARLES CHRIS (DDS)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:CHRIS
Last Name:BALLARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2506 AUTUMN GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77345-2233
Mailing Address - Country:US
Mailing Address - Phone:281-360-6019
Mailing Address - Fax:281-361-0762
Practice Address - Street 1:2506 AUTUMN GARDEN CT
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77345-2233
Practice Address - Country:US
Practice Address - Phone:281-360-6019
Practice Address - Fax:281-361-0762
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15124207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX760538820OtherTAX ID