Organization
KOOL KOALA PEDIATRIC AND ADOLESCENT DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FREDERICK VERNON BALLARD JR. DDS (CEO)
(856) 230-0924
Entity
Organization
Contact information
Practice address
501 WHITEHORSE PIKE, COLLINGSWOOD, NJ 08107
(856) 230-0924
Mailing address
501 WHITEHORSE PIKE, COLLINGSWOOD, NJ 08107
(856) 230-0924
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
22DIO2447503
NJ
Other
Enumeration date
04/30/2015
Last updated
04/30/2015
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