Individual
DR. PAUL EDWARD BALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3040 INDIANA AVE, VICKSBURG, MS 39180-4355
(601) 634-6277
(601) 634-0153
Mailing address
3040 INDIANA AVE, VICKSBURG, MS 39180-5415
(601) 634-6277
(601) 634-0153
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2063-84
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00066273
—
MS
Enumeration date
05/24/2007
Last updated
07/08/2007
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