Provider Demographics
NPI:1861424848
Name:BALLARD, STEPHEN W (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:W
Last Name:BALLARD
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 1:2998 GINNALA DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-7819
Mailing Address - Country:US
Mailing Address - Phone:970-669-1236
Mailing Address - Fax:970-622-8521
Practice Address - Street 1:2998 GINNALA DR
Practice Address - Street 2:SUITE 101
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-7819
Practice Address - Country:US
Practice Address - Phone:970-669-1236
Practice Address - Fax:970-622-8521
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1058131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice