Provider Demographics
NPI:1003240540
Name:BALDA, CHRISTOPHER V (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:V
Last Name:BALDA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11232 E LINCOLNSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-4479
Mailing Address - Country:US
Mailing Address - Phone:217-343-0444
Mailing Address - Fax:
Practice Address - Street 1:401 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-3442
Practice Address - Country:US
Practice Address - Phone:217-342-3411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-31
Last Update Date:2013-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190296061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice