Provider Demographics
NPI:1932217726
Name:BALL, MARC LEE (DDS)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:LEE
Last Name:BALL
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 1:620 N EMERSON ST
Mailing Address - Street 2:STE 103
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-6619
Mailing Address - Country:US
Mailing Address - Phone:509-662-9685
Mailing Address - Fax:509-662-5099
Practice Address - Street 1:620 N EMERSON ST
Practice Address - Street 2:STE 103
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-6619
Practice Address - Country:US
Practice Address - Phone:509-662-9685
Practice Address - Fax:509-662-5099
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5215122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6729430001OtherMEDICARE PTAN