Provider Demographics
NPI:1447311535
Name:BALL, MARK STEVEN (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
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:PO BOX 1347
Mailing Address - Street 2:
Mailing Address - City:HONAKER
Mailing Address - State:VA
Mailing Address - Zip Code:24260-1347
Mailing Address - Country:US
Mailing Address - Phone:276-873-4003
Mailing Address - Fax:276-873-5968
Practice Address - Street 1:126 REDBUD HIGHWAY
Practice Address - Street 2:
Practice Address - City:HONAKER
Practice Address - State:VA
Practice Address - Zip Code:24260
Practice Address - Country:US
Practice Address - Phone:276-873-4003
Practice Address - Fax:276-873-5968
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010059531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9178536Medicaid
VA8660OtherPROVIDER NUMBER