Provider Demographics
NPI:1467667279
Name:BALIAN, ALEXANDER HAIG (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:HAIG
Last Name:BALIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7119 SALEM FIELDS BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-2541
Mailing Address - Country:US
Mailing Address - Phone:540-786-2000
Mailing Address - Fax:540-786-7469
Practice Address - Street 1:7119 SALEM FIELDS BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-2541
Practice Address - Country:US
Practice Address - Phone:540-786-2000
Practice Address - Fax:540-786-7469
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA7210122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist