Provider Demographics
NPI:1346530102
Name:BALABEGIAN, TENNY
Entity Type:Individual
Prefix:
First Name:TENNY
Middle Name:
Last Name:BALABEGIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10028 LEONA ST
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-2535
Mailing Address - Country:US
Mailing Address - Phone:818-399-0550
Mailing Address - Fax:
Practice Address - Street 1:10028 LEONA ST
Practice Address - Street 2:
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-2535
Practice Address - Country:US
Practice Address - Phone:818-399-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV61901223X0400X
CA632431223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics