Provider Demographics
NPI:1043557580
Name:BALASANYAN BRUN TRIPP SLAUGHTER PLLC
Entity Type:Organization
Organization Name:BALASANYAN BRUN TRIPP SLAUGHTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BALASANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-442-7175
Mailing Address - Street 1:6842 MORRISON BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-3500
Mailing Address - Country:US
Mailing Address - Phone:704-442-7175
Mailing Address - Fax:
Practice Address - Street 1:6842 MORRISON BLVD STE 202
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-3500
Practice Address - Country:US
Practice Address - Phone:704-442-7175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BALASANYAN BRUN TRIPP SLAUGHTER PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty