Individual
MRS. MARTINA BALLAST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
563 W 184TH ST, SUITE 1, NEW YORK, NY 10033-4128
(212) 543-3000
(212) 543-9769
Mailing address
7 SLOCUM AVE., ENGLEWOOD, NJ 07631
(201) 871-3581
(212) 543-9769
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
046143
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01643787
—
NY
Enumeration date
03/30/2007
Last updated
07/08/2007
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