Eric Ballou, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D-4142 Issued in ID

Practice address

5355 W State St
Boise, ID 83703-3333

Phone

(208) 853-4687

Fax

(208) 853-4690

NPI assigned

Jun 12, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

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

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lake Harbor Dental PLLC

  • Dental Clinic/Center
  • Boise, ID
  • NPI 1427669720
  NPD Authorized official

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

{
    "created_epoch": "1213228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707696000000",
    "number": "1952561003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5355 W STATE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837033333",
            "telephone_number": "208-853-4687",
            "fax_number": "208-853-4690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5355 W STATE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837033333",
            "telephone_number": "208-853-4687",
            "fax_number": "208-853-4690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALLOU",
        "first_name": "ERIC",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-12",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D-4142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Ballard, LCSW
• Brooke Taylor Ballenberg, LPC, NCC
• Elizabeth Balleweg
• Jay T. Ballhagen, M.D.
• Angeles L Ballou, FNP
• Christy Baltazor, M.S., CF-SLP
• Amy Niblock Balzer, LCSW
• Emmanuel Bampendi
• Elizabeth Campos Banda
• Teisha Banda, PT

• Dentist in Boise, ID
• Providers in Boise, ID by specialty
• Dentist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2024; 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.