Provider Demographics
NPI:1366678716
Name:BAL, MANJIT K (DMD)
Entity Type:Individual
Prefix:DR
First Name:MANJIT
Middle Name:K
Last Name:BAL
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 1:1019 DIVISION AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-1633
Mailing Address - Country:US
Mailing Address - Phone:253-383-2300
Mailing Address - Fax:253-383-9057
Practice Address - Street 1:1019 DIVISION AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-1633
Practice Address - Country:US
Practice Address - Phone:253-383-2300
Practice Address - Fax:253-383-9057
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00009290122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist