Stephanie Earline Ballentine, DDS PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4831 Issued in NC

Practice address

1315 Matheson Ave
Charlotte, NC 28205-1670

Phone

(704) 334-6907

Fax

(704) 376-4773

NPI assigned

Feb 19, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1171843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1780728048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1315 MATHESON AVE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282051670",
            "telephone_number": "704-334-6907",
            "fax_number": "704-376-4773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1315 MATHESON AVE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282051670",
            "telephone_number": "704-334-6907",
            "fax_number": "704-376-4773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALLENTINE",
        "first_name": "STEPHANIE",
        "middle_name": "EARLINE",
        "name_prefix": "Dr.",
        "credential": "DDS PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "4831",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8990381",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marquiez Denise Ballard, PA-C
• Stacy Leigh Ballard, NP
• Jeffrey Tim Ballast, PA
• Jessica Ballentine
• Keundra Ballentine
• William E Ballinger Jr., M.D.
• Maya Simone White Ballou, LCAS-A
• Lily Balmer
• Usha Balmuri, MD
• Valerie G. Balog

• General Practice Dentistry in Charlotte, NC
• Providers in Charlotte, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.