Organization
JOSEPH D. BALLENGER JR. DDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH DAVID BALLENGER JR. DDS PA (OWNER)
(208) 467-1227
Entity
Organization
Contact information
Practice address
339 W IOWA AVE, NAMPA, ID 83686-2856
(208) 467-1227
(208) 467-1299
Mailing address
339 W IOWA AVE, NAMPA, ID 83686-2856
(208) 467-1227
(208) 467-1299
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D-2042-OS
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0026640000
—
ID
05
—
805475200
—
ID
Enumeration date
09/10/2007
Last updated
02/26/2008
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