Provider Demographics
NPI:1053506576
Name:BALBUENA, CECILIA A (DDS)
Entity Type:Individual
Prefix:MRS
First Name:CECILIA
Middle Name:A
Last Name:BALBUENA
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 1:845 W TILGHMAN STREET
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-2301
Mailing Address - Country:US
Mailing Address - Phone:610-433-4533
Mailing Address - Fax:610-433-4543
Practice Address - Street 1:845 W TILGHMAN STREET
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-2301
Practice Address - Country:US
Practice Address - Phone:610-433-4533
Practice Address - Fax:610-433-4543
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS035060122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01940331Medicaid