Provider Demographics
NPI:1104964402
Name:BALLDINGER & MILLER
Entity type:Organization
Organization Name:BALLDINGER & MILLER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:MERRILL
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:202-298-6111
Mailing Address - Street 1:1747 PENNSYLVANIA AVE NW
Mailing Address - Street 2:G-100
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-4604
Mailing Address - Country:US
Mailing Address - Phone:202-298-6111
Mailing Address - Fax:202-526-9456
Practice Address - Street 1:1747 PENNSYLVANIA AVE NW
Practice Address - Street 2:G-100
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-4604
Practice Address - Country:US
Practice Address - Phone:202-298-6111
Practice Address - Fax:202-526-9456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN23871223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty