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Organization
ORAL FACIAL AND PERIODONTAL SURGERY LLC
Active
Organization
ORAL FACIAL AND PERIODONTAL SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY BALLARD DDS (OWNER)
(262) 886-0147
Entity
Organization
Contact information
Practice address
13200 GLOBE DR STE 108, MT PLEASANT, WI 53177-1606
(262) 886-0147
Mailing address
13200 GLOBE DR STE 108, MT PLEASANT, WI 53177-1606
(262) 886-0147
(262) 886-0570
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
10/27/2016
Last updated
07/21/2025
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