Provider Demographics
NPI:1528218674
Name:BALUYUT, AMY R (D M D)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:R
Last Name:BALUYUT
Suffix:
Gender:F
Credentials:D M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 BLOSSOM CIR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-6448
Mailing Address - Country:US
Mailing Address - Phone:757-301-6310
Mailing Address - Fax:
Practice Address - Street 1:720 BLOSSOM CIR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-6448
Practice Address - Country:US
Practice Address - Phone:757-301-6310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014105521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice