Provider Demographics
NPI:1316065212
Name:BALLAR, ALLEN WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:WILLIAM
Last Name:BALLAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3772 SATELLITE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5681
Mailing Address - Country:US
Mailing Address - Phone:770-497-1045
Mailing Address - Fax:770-623-6288
Practice Address - Street 1:3772 SATELLITE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5681
Practice Address - Country:US
Practice Address - Phone:770-497-1045
Practice Address - Fax:770-623-6288
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA83211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice