Organization
WILDWIND DENTAL
Active
Other names
Ellen Ballard DDS
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELLEN VANDERGUST BALLARD DDS (PRESIDENT WILDWIND DENTAL)
(505) 672-2020
Entity
Organization
Contact information
Practice address
111 LONGVIEW DRIVE, SUITE B3, LOS ALAMOS, NM 87544
(505) 672-2020
(505) 672-2020
Mailing address
203 RIO BRAVO, LOS ALAMOS, NM 87544
(505) 920-1065
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1668
NM
Other
Enumeration date
05/03/2007
Last updated
08/22/2020
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