Provider Demographics
NPI:1437566775
Name:BALLARD, ROBIN (DH)
Entity type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:
Last Name:BALLARD
Suffix:
Gender:F
Credentials:DH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 131ST ST S
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-4804
Mailing Address - Country:US
Mailing Address - Phone:253-539-7445
Mailing Address - Fax:253-539-7538
Practice Address - Street 1:130 131ST ST S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-4804
Practice Address - Country:US
Practice Address - Phone:253-539-7445
Practice Address - Fax:253-539-7538
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00002672124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist