Provider Demographics
NPI:1326500844
Name:DR. MICHAEL BALIKYAN, INC
Entity Type:Organization
Organization Name:DR. MICHAEL BALIKYAN, INC
Other - Org Name:SOUTH LAKE DENTAL, DENTAL OFFICE OF DR. MICHAEL BALIKYAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BALIKYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-844-6684
Mailing Address - Street 1:903 E DEL MAR BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-3201
Mailing Address - Country:US
Mailing Address - Phone:626-844-6674
Mailing Address - Fax:626-844-6638
Practice Address - Street 1:903 E DEL MAR BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-3201
Practice Address - Country:US
Practice Address - Phone:626-844-6674
Practice Address - Fax:626-844-6638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-03
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty