Individual
TIFFANY BALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LDH
Contact information
Practice address
3229 BROADWAY STE 115, GARY, IN 46409-1040
(219) 806-3000
Mailing address
2673 W 86TH AVE, MERRILLVILLE, IN 46410-6948
(317) 629-9014
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
13007024A
IN
Other
Enumeration date
10/09/2019
Last updated
10/09/2019
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