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
—
—
Other
Enumeration date
10/27/2016
Last updated
07/21/2025
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