Provider Demographics
NPI:1013555317
Name:BALAZE & GREGG DENTISTRY
Entity Type:Organization
Organization Name:BALAZE & GREGG DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BALAZE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:949-770-7686
Mailing Address - Street 1:30131 TOWN CENTER DR STE 250
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2082
Mailing Address - Country:US
Mailing Address - Phone:949-770-7686
Mailing Address - Fax:
Practice Address - Street 1:30131 TOWN CENTER DR STE 250
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2082
Practice Address - Country:US
Practice Address - Phone:949-770-7686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental