Provider Demographics
NPI:1699946400
Name:BALLINGER, MISTY (RDH)
Entity type:Individual
Prefix:MS
First Name:MISTY
Middle Name:
Last Name:BALLINGER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 WILMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-7166
Mailing Address - Country:US
Mailing Address - Phone:704-838-1108
Mailing Address - Fax:
Practice Address - Street 1:1421 WILMINGTON AVE
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-7166
Practice Address - Country:US
Practice Address - Phone:704-838-1108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6693124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist