Ellen Vandergust Ballard, DDS
Individual provider Active NPI General Practice Dentistry · White Rock, NM
NPI 1649452129 · NPPES record last updated Nov 27, 2007
Key facts
- NPI
- 1649452129
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 1668 (NM)
- Practice address
- 111 Longview
Suite B-3
White Rock, NM 87544 - Phone
- (505) 672-2020
- Fax
- (505) 672-2020
- NPI assigned
- Nov 27, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1668 | NM | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wildwind Dental | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 1668 | NM | Yes |
Addresses
Primary practice location
111 Longview
Suite B-3
White Rock, NM 87544
Mailing address
111 Longview
Suite B-3
White Rock, NM 87544
Phone (505) 672-2020
Other providers in White Rock, NM
- Erin McGinty James
- Lamc White Rock Pharmacy
- Natalino Physical Therapy
- Howard Hassell Pack
- Jesse James Robinson
All providers in White Rock, NM · General Practice Dentistry in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 27, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.