Provider Demographics
NPI:1033121512
Name:BALTZ, KARLA T (DDS)
Entity Type:Individual
Prefix:DR
First Name:KARLA
Middle Name:T
Last Name:BALTZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-1364
Mailing Address - Country:US
Mailing Address - Phone:870-892-1211
Mailing Address - Fax:870-892-4804
Practice Address - Street 1:151 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-1364
Practice Address - Country:US
Practice Address - Phone:870-892-1211
Practice Address - Fax:870-892-4804
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR31401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR127294608Medicaid
AR876596OtherUNITED CONCORDIA
AR5T016OtherBLUE CROSS BLUE SHIELD