Provider Demographics
NPI:1073726402
Name:BALADAD, LUZ NANA (DMD)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:NANA
Last Name:BALADAD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1296 ARABELLE WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-2882
Mailing Address - Country:US
Mailing Address - Phone:408-646-8202
Mailing Address - Fax:
Practice Address - Street 1:1117 TASMAN DR
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94089-2228
Practice Address - Country:US
Practice Address - Phone:408-752-0684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA470401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice