BALLANCE & DEROSE DDS PA (NPI# 1386677961) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386677961 |
| Entity Type | Organization |
| Organization Name | BALLANCE & DEROSE DDS PA |
| Practice Address |
1400 Walter Reed Rd Suite 200 Fayetteville NC 28304-4409 |
| Mailing Address |
2041 Silas Creek Pkwy Winston Salem NC 27103-5147 |
| Practice Telephone | 9108649884 |
| Mailing Telephone | 3367770303 |
| Mailing Fax Number | 3367773448 |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. MICHAEL ANTHONY DEROSE (OWNER) |
| Authorized Official Telephone | 3367770303 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UNITED CONCORDIA | 1945717 | 01 | |
| NC | 5903665 | 05 | |
| BLUE CROSS BLUE SHIELD NC | 018C1 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053344630 | Ballance & Derose Dds Pa | Dentist | 900 Summit Ave, Greensboro, NC 27405-7918 | 2006-07-08 |
| 1982632535 | Ballance & Derose Dds Pa | Dentist | 247 Biltmore Ave, Asheville, NC 28801-4107 | 2006-06-30 |
| Street Address |
1400 WALTER REED RD SUITE 200 |
| City | FAYETTEVILLE |
| State | NC |
| Zip Code | 28304-4409 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861429284 | Thomas Hugo Hamilton Jr. | Dentist | 1400 Walter Reed Rd, Suite 200, Fayetteville, NC 28304-4409 | 2006-06-28 |
| 1528485968 | Biniam Tecle | Dentist | 1400 Walter Reed Rd, Fayetteville, NC 28304-4409 | 2014-03-24 |
| 1285919902 | Kingsley Oise Momodu | Dentist | 1400 Walter Reed Rd, Fayetteville, NC 28304-4409 | 2011-10-13 |
| 1285803197 | Rafael Rivera, Jr., Dds, Pllc | Dentist | 1400 Walter Reed Rd, Fayetteville, NC 28304-4409 | 2008-02-25 |
| 1922214691 | Roselyn Brooks Kennedy | Dentist | 1400 Walter Reed Rd, Ste 200, Fayetteville, NC 28304-4411 | 2007-05-16 |
| 1952418618 | Mark Tague Carlson | Dentist | 1400 Walter Reed Rd, Suite 200, Fayetteville, NC 28304-4409 | 2006-08-25 |
| 1952313090 | Paige E Nance | Dentist | 1400 Walter Reed Rd, Suite 200, Fayetteville, NC 28304-4409 | 2006-08-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598301061 | Coast To Coast Bilingual Counseling | Social Worker | 910 Hope Mills Road, Fayetteville, NC 28304 | 2019-11-20 |
| 1811530561 | Frances L. Hurst | Technician | 6732 Carloway Dr, Fayetteville, NC 28304 | 2019-10-25 |
| 1538717764 | Rose Mary A O'conner | Technician | 3530 Madison Ave, Fayetteville, NC 28304 | 2019-08-30 |
| 1932756087 | Sally Frances Jones | Technician | 2053 Mango Circle, Fayetteville, NC 28304 | 2019-08-23 |
| 1326528803 | Jeneen Yvette Townsend | Counselor | 2671 Adams Lake Dr Apt F, Fayetteville, NC 28304 | 2018-08-15 |
| 1780179580 | Ma Cornelia Villavicencio Leano | Nurse Practitioner | 3081 Stone Carriage Cir Apt Z, Fayetteville, NC 28304 | 2018-06-25 |
| 1861986267 | Pediatric After Hours Care of Fayetteville | Pediatrics | 556 Sandhurst Drive, Fayetteville, NC 28304 | 2018-06-19 |
| 1700386133 | Good Night Medical of Ohio, LLC | Durable Medical Equipment & Medical Supplies | 405 Owen Dr Ste 202, Fayetteville, NC 28304 | 2018-02-12 |
| 1003321365 | Valleygate Dental Surgery Center of Fayetteville, LLC | Dentist | 2038 Litho Place, Fayetteville, NC 28304 | 2017-12-08 |
| 1871004663 | The Salt Project | Marriage & Family Therapist | 1611-b Owen Dr., Fayetteville, NC 28304 | 2017-10-19 |
| Find all providers in zip 28304 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346898335 | Chaitanya Joopally Dds Pllc | Dentist | 2050 Skibo Rd. Ste 104, Fayetteville, NC 28314 | 2019-09-03 |
| 1972151439 | Ikenna K Okons | Dentist | 4200 Morganton Rd Ste 304, Fayetteville, NC 28314-1564 | 2019-08-28 |
| 1114488079 | Bianca Kristina Adams | Dentist | 207 Forest Creek Dr, Fayetteville, NC 28303-5496 | 2019-03-25 |
| 1194226506 | Michael E. Carter, Dds, Pllc | Dentist | 1874 N Hunters Rdg Ste 1, Fayetteville, AR 72701-2896 | 2018-02-22 |
| 1760900153 | Elali Alisha Marie Moukwa | Dentist | 1916 Skibo Rd Ste C3, Fayetteville, NC 28314 | 2017-09-06 |
| 1548781107 | Christopher Heard | Dentist | 265 N Jeff Davis Dr Ste 1a, Fayetteville, GA 30214-1668 | 2017-07-03 |
| 1881123305 | Kenneth Boyd Lewis Jr. | Dentist | 4140 Ramsey St Ste 104, Fayetteville, NC 28311-7658 | 2017-06-08 |
| 1518496215 | Van Michael Mcqueen Jr. | Dentist | 640 N Garland Ave # 104, Fayetteville, AR 72701 | 2017-06-06 |
| 1710415229 | Alan Kuo | Dentist | 1400 Walter Reed Rd Ste 200, Fayetteville, NC 28304 | 2017-05-28 |
| 1508304866 | Karan G Mirchandani | Dentist | 4251 Ramsey St Ste 8, Fayetteville, NC 28311-2130 | 2017-02-07 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 28304 |
Please comment or provide details below to improve the information on BALLANCE & DEROSE DDS PA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.