Provider Demographics
NPI:1386665362
Name:RICHARD L. BALICK, DMD
Entity Type:Organization
Organization Name:RICHARD L. BALICK, DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:BALICK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-966-1166
Mailing Address - Street 1:4700 SHERIDAN ST
Mailing Address - Street 2:STE A
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3420
Mailing Address - Country:US
Mailing Address - Phone:954-966-1166
Mailing Address - Fax:954-966-7622
Practice Address - Street 1:4700 SHERIDAN ST
Practice Address - Street 2:STE A
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3420
Practice Address - Country:US
Practice Address - Phone:954-966-1166
Practice Address - Fax:954-966-7622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL95351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty