Provider Demographics
NPI:1699803296
Name:JAMES W BALLARD, DDS
Entity type:Organization
Organization Name:JAMES W BALLARD, DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES. OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILTON
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-635-4707
Mailing Address - Street 1:PO BOX 1068
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCISVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70775-1068
Mailing Address - Country:US
Mailing Address - Phone:225-635-4707
Mailing Address - Fax:225-635-2172
Practice Address - Street 1:7181 US HWY. 61
Practice Address - Street 2:SUITE 10
Practice Address - City:SAINT FRANCISVILLE
Practice Address - State:LA
Practice Address - Zip Code:70775
Practice Address - Country:US
Practice Address - Phone:225-635-4707
Practice Address - Fax:225-635-2172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2786261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1827860Medicaid