Provider Demographics
NPI:1437580404
Name:BALAN, KALA (DMD)
Entity Type:Individual
Prefix:
First Name:KALA
Middle Name:
Last Name:BALAN
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 1:1838 MICCOSUKEE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5250
Mailing Address - Country:US
Mailing Address - Phone:850-878-1345
Mailing Address - Fax:850-878-5496
Practice Address - Street 1:1838 MICCOSUKEE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5250
Practice Address - Country:US
Practice Address - Phone:850-878-1345
Practice Address - Fax:850-878-5496
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN153511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN 15351OtherDENTAL LICENSE