Provider Demographics
NPI:1548444698
Name:BALLARD FAMILY DENTISTRY L.L.C.
Entity type:Organization
Organization Name:BALLARD FAMILY DENTISTRY L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-756-8976
Mailing Address - Street 1:2900 KIRBY RD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-8221
Mailing Address - Country:US
Mailing Address - Phone:901-756-8976
Mailing Address - Fax:901-756-8547
Practice Address - Street 1:2900 KIRBY PARKWAY
Practice Address - Street 2:SUITE 12
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-8221
Practice Address - Country:US
Practice Address - Phone:901-756-8976
Practice Address - Fax:901-756-8547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7025122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty