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Organization
STEPHANIEBALLENTINE,DDS,PA
Active
Organization
STEPHANIEBALLENTINE,DDS,PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHANIE BALLENTINE DDS (PRESIDENT)
(704) 334-6907
Entity
Organization
Contact information
Practice address
1315 MATHESON AVE, CHARLOTTE, NC 28205-1670
(704) 334-6907
(704) 376-4773
Mailing address
1315 MATHESON AVE, CHARLOTTE, NC 28205-1670
(704) 334-6907
(704) 376-4773
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4831
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8990381
—
NC
Enumeration date
05/08/2007
Last updated
08/22/2020
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