Provider Demographics
NPI:1538798467
Name:BALL, CORY ALLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:CORY
Middle Name:ALLEN
Last Name:BALL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 RISDON TRL S
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-2801
Mailing Address - Country:US
Mailing Address - Phone:616-334-5574
Mailing Address - Fax:
Practice Address - Street 1:100 POWELL DR STE 5
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:MI
Practice Address - Zip Code:48131-8645
Practice Address - Country:US
Practice Address - Phone:734-823-5990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016004671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice