Organization
MARK R BALLENTINE DDS,PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK ROBERT BALLENTINE DDS,PLLC (SOLE OWNER)
(313) 383-8960
Entity
Organization
Contact information
Practice address
9815 REECK RD, ALLEN PARK, MI 48101-1356
(313) 383-8960
(313) 383-7313
Mailing address
9815 REECK RD, ALLEN PARK, MI 48101-1356
(313) 383-8960
(313) 383-7313
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D12983
MI
Other
Enumeration date
12/12/2008
Last updated
12/12/2008
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