Provider Demographics
NPI:1093989956
Name:BALGOBIND, SURENDRA PRASAD (DDS)
Entity Type:Individual
Prefix:
First Name:SURENDRA
Middle Name:PRASAD
Last Name:BALGOBIND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4057
Mailing Address - Country:US
Mailing Address - Phone:209-527-5115
Mailing Address - Fax:
Practice Address - Street 1:1429 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4057
Practice Address - Country:US
Practice Address - Phone:209-527-5115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40411122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist