| NPI | 1295112043 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FREDERICK VERNON BALLARD CEO 856-230-0924 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DIO2447503) |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2015-04-30 |