Provider Demographics
NPI:1417479619
Name:BALBIERZ, MADISON M (DDS)
Entity Type:Individual
Prefix:DR
First Name:MADISON
Middle Name:M
Last Name:BALBIERZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:
Other - Last Name:HORSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:232 N SENECA ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-6023
Mailing Address - Country:US
Mailing Address - Phone:316-262-5273
Mailing Address - Fax:316-262-0133
Practice Address - Street 1:232 N SENECA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-6023
Practice Address - Country:US
Practice Address - Phone:316-262-5273
Practice Address - Fax:316-262-0133
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS613761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice