Provider Demographics
NPI:1083735831
Name:BALANCIO, CLARA ESPINOZA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLARA
Middle Name:ESPINOZA
Last Name:BALANCIO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:CLARA
Other - Middle Name:SUZARA
Other - Last Name:ESPINOZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:91 GREGORY LN
Mailing Address - Street 2:STE# 9
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4981
Mailing Address - Country:US
Mailing Address - Phone:925-671-9177
Mailing Address - Fax:925-726-2479
Practice Address - Street 1:91 GREGORY LN
Practice Address - Street 2:STE# 9
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4981
Practice Address - Country:US
Practice Address - Phone:925-671-9177
Practice Address - Fax:925-726-2479
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA490401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA27-2050534OtherTIN#