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Individual

RANDALL E BALLWEG

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
1250 PRAIRIE ST, PRAIRIE DU SAC, WI 53578-2041
(608) 643-8505
(608) 643-8097
Mailing address
1250 PRAIRIE ST, PRAIRIE DU SAC, WI 53578-2041
(608) 643-8505
(608) 643-8097

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5002051-015
WI

Other

Enumeration date
01/11/2006
Last updated
07/08/2007
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