Provider Demographics
NPI:1275104846
Name:BALOGH, NHI (DMD)
Entity Type:Individual
Prefix:
First Name:NHI
Middle Name:
Last Name:BALOGH
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 1:4100 WEEKS PARK LN APT 111
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-3223
Mailing Address - Country:US
Mailing Address - Phone:323-712-1771
Mailing Address - Fax:
Practice Address - Street 1:5200 STONE LAKE DR
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-8020
Practice Address - Country:US
Practice Address - Phone:940-341-2119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX373131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice