Provider Demographics
NPI:1083823587
Name:BALABA, ANGELA SUSAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:SUSAN
Last Name:BALABA
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 1:13823 OUTLET DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-4971
Mailing Address - Country:US
Mailing Address - Phone:301-890-8005
Mailing Address - Fax:301-890-1485
Practice Address - Street 1:13823 OUTLET DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-4971
Practice Address - Country:US
Practice Address - Phone:301-890-8005
Practice Address - Fax:301-890-1485
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD99891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice