Kool Koala Pediatric and Adolescent Dentistry

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

22DIO2447503 Issued in NJ

Legal business name

KOOL KOALA PEDIATRIC AND ADOLESCENT DENTISTRY

Practice address

501 Whitehorse Pike
Collingswood, NJ 08107

Phone

(856) 230-0924

NPI assigned

Apr 30, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Frederick Vernon Ballard Jr., DDSNPI 1003061276

Title

Ceo

Phone

(856) 230-0924

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Frederick Vernon Ballard Jr., D.D.S.

  • Pediatric Dentistry
  • West Collingswood, NJ
  • NPI 1003061276
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1430352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430352000000",
    "number": "1295112043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 WHITEHORSE PIKE",
            "city": "COLLINGSWOOD",
            "state": "NJ",
            "postal_code": "08107",
            "telephone_number": "856-230-0924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 WHITEHORSE PIKE",
            "city": "COLLINGSWOOD",
            "state": "NJ",
            "postal_code": "08107",
            "telephone_number": "856-230-0924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOOL KOALA PEDIATRIC AND ADOLESCENT DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-30",
        "last_updated": "2015-04-30",
        "status": "A",
        "authorized_official_last_name": "BALLARD",
        "authorized_official_first_name": "FREDERICK",
        "authorized_official_middle_name": "VERNON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "856-230-0924",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NJ",
            "license": "22DIO2447503",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abbie Kasoff
• Deborah A Kauterman, OT
• Michele Marlene Keyes, LSW
• Sharon Elizabeth King, LPC
• Donna L Knorr, PT
• Alisha M Kothari, OD
• Sheri Lee Krauss, A.C.
• Michael Scott Kresloff, M.D.
• Richard Stephen Kresloff, M.D.
• Carl Anthony Lange Jr.

• Pediatric Dentistry in Collingswood, NJ
• Providers in Collingswood, NJ by specialty
• Pediatric Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.