Organization
BALLARD DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL E BALLARD DMD (OWNER)
(601) 634-6277
Entity
Organization
Contact information
Practice address
3040 INDIANA AVENUE, VICKSBURG, MS 39180
(601) 634-6277
(601) 634-0153
Mailing address
3040 INDIANA AVENUE, VICKSBURG, MS 39180
(601) 634-6277
(601) 634-0153
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2063-84
MS
Other
Enumeration date
11/17/2006
Last updated
08/22/2020
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