Provider Demographics
NPI:1144766528
Name:CARREL BALDERSTON DDS INC
Entity Type:Organization
Organization Name:CARREL BALDERSTON DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDERSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-872-2489
Mailing Address - Street 1:1074 EAST AVE
Mailing Address - Street 2:SUITE U
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1005
Mailing Address - Country:US
Mailing Address - Phone:530-342-8580
Mailing Address - Fax:
Practice Address - Street 1:1074 EAST AVE
Practice Address - Street 2:SUITE U
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1005
Practice Address - Country:US
Practice Address - Phone:530-342-8580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42119261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental