Provider Demographics
NPI:1003425513
Name:BERRIEN DENTAL PLC
Entity Type:Organization
Organization Name:BERRIEN DENTAL PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BALSIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:269-471-4055
Mailing Address - Street 1:8383 M 139
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-9001
Mailing Address - Country:US
Mailing Address - Phone:269-471-4055
Mailing Address - Fax:269-471-3829
Practice Address - Street 1:8383 M 139
Practice Address - Street 2:
Practice Address - City:BERRIEN SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49103-9001
Practice Address - Country:US
Practice Address - Phone:269-471-4055
Practice Address - Fax:269-471-3829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty