# JOSEPH D BALLENGER JR, DDS, PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Comstock & Ballenger LLS
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497858203
- **Authorized official:** JOSEPH D BALLENGER JR. DDS, PA (ORAL & MAXILLONFACIAL SURGEON)
- **Authorized official phone:** (208) 452-4808

## Contact information

- **Practice address:** 211 N WHITLEY DR, SUITE 3, FRUITLAND, ID 83619-2704
- **Practice address phone:** (208) 452-4808
- **Practice address fax:** (208) 452-4816
- **Mailing address:** 211 N WHITLEY DR, SUITE 3, FRUITLAND, ID 83619-2704
- **Mailing address phone:** (208) 452-4808
- **Mailing address fax:** (208) 452-4816

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | D-2042-05 | ID | Yes |

## Other

- **Enumeration date:** 09/07/2006
- **Last updated:** 08/22/2020