Joseph D Ballenger Jr, DDS, PA

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D-2042-05 Issued in ID

Legal business name

JOSEPH D BALLENGER JR, DDS, PA

Practice address

211 N Whitley Dr
Suite 3
Fruitland, ID 83619-2704

Phone

(208) 452-4808

Fax

(208) 452-4816

NPI assigned

Sep 7, 2006

Organization subpart

No

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

Authorized official

Name

Joseph D Ballenger Jr., DDS, PA

Title

Oral & Maxillonfacial Surgeon

Phone

(208) 452-4808

Specialties & licenses 1

Addresses

Other names 1

• Comstock & Ballenger LLS Former legal business name

Locations

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497858203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 N WHITLEY DR",
            "address_2": "SUITE 3",
            "city": "FRUITLAND",
            "state": "ID",
            "postal_code": "836192704",
            "telephone_number": "208-452-4808",
            "fax_number": "208-452-4816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 N WHITLEY DR",
            "address_2": "SUITE 3",
            "city": "FRUITLAND",
            "state": "ID",
            "postal_code": "836192704",
            "telephone_number": "208-452-4808",
            "fax_number": "208-452-4816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOSEPH D BALLENGER JR, DDS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BALLENGER",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "ORAL & MAXILLONFACIAL SURGEON",
        "authorized_official_telephone_number": "208-452-4808",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS, PA"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "ID",
            "license": "D-2042-05",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Comstock & Ballenger LLS",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Trenton John Jenks, PHARM. D, CGP
• Michael Jeppesen, DPT
• Brett Johansen, PA-C
• Lynn R Johnson, PT; LAT
• Jessica Lynn Jones, LMSW
• Janette Kameshige, RPH
• Crysta Kimes, PA
• Nate Kinghorn
• Judd Alan Knudsen, RPH
• Kira Koenig, PTA

• Oral and Maxillofacial Surgery (Dentist) in Fruitland, ID
• Providers in Fruitland, ID by specialty
• Oral and Maxillofacial Surgery (Dentist) in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.