| Ballance & Derose Dds Pa | |
|
1400 Walter Reed Rd Suite 200 Fayetteville NC 28304-4409 | |
| (910) 864-9884 | |
| Not Available |
| Full Name | Ballance & Derose Dds Pa |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1400 Walter Reed Rd, Fayetteville, North Carolina |
| Authorized Official Name and Position | Michael Anthony Derose (OWNER) |
| Authorized Official Contact | 3367770303 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ballance & Derose Dds Pa 2041 Silas Creek Pkwy Winston Salem NC 27103-5147 Ph: (336) 777-0303 | Ballance & Derose Dds Pa 1400 Walter Reed Rd Suite 200 Fayetteville NC 28304-4409 Ph: (910) 864-9884 |
| NPI Number | 1386677961 |
|---|---|
| Provider Enumeration Date | 07/08/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386677961 | NPI | - | NPPES |
| 018C1 | Other | BLUE CROSS BLUE SHIELD NC | |
| 5903665 | Medicaid | NC | |
| 1945717 | Other | UNITED CONCORDIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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