Provider Demographics
NPI:1457478141
Name:BALIAN, ARTHUR YERVANT (DMD)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:YERVANT
Last Name:BALIAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STURBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01566-1540
Mailing Address - Country:US
Mailing Address - Phone:617-775-9612
Mailing Address - Fax:508-347-7564
Practice Address - Street 1:4 ALBERT ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-1304
Practice Address - Country:US
Practice Address - Phone:508-832-4141
Practice Address - Fax:508-721-0753
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA194841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice