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1952561003
ERIC BALLOU
BOISE, ID
NPI
1952561003
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
122300000X Dentist
(Licence: ID D-4142)
Enumeration Date
2008-06-12
Last Update Date
2024-02-12
Business Address
ERIC BALLOU DDS
5355 W STATE ST
BOISE, ID 83703-3333
Phone number: 208-853-4687
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Mailing Address
ERIC BALLOU DDS
5355 W STATE ST
BOISE, ID 83703-3333
Phone number: 208-853-4687
Copy
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