1699803296 NPI number — JAMES W BALLARD, DDS

Table of content: (NPI 1699803296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699803296 NPI number — JAMES W BALLARD, DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES W BALLARD, DDS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FELICIANA DENTAL CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699803296
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1068
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT FRANCISVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70775-1068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-635-4707
Provider Business Mailing Address Fax Number:
225-635-2172

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7181 US HWY. 61
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
SAINT FRANCISVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-635-4707
Provider Business Practice Location Address Fax Number:
225-635-2172
Provider Enumeration Date:
03/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BALLARD
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
WILTON
Authorized Official Title or Position:
PRES. OF CORPORATION
Authorized Official Telephone Number:
225-635-4707

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  2786 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1827860 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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