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Individual

DR. DARYL DUANE BALLARD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
1051 COLUMBIA AVE, CONNELL, WA 99326-8702
(509) 488-5256
(509) 488-9939
Mailing address
1515 E COLUMBIA ST, OTHELLO, WA 99344-1846
(509) 488-5256
(509) 488-9939

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
60196099
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2095670
WA
Enumeration date
08/16/2006
Last updated
10/14/2020
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