Provider Demographics
NPI:1528225703
Name:MARIA B. BALAGTAS DDS,INC
Entity Type:Organization
Organization Name:MARIA B. BALAGTAS DDS,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:BUENAVENTURA
Authorized Official - Last Name:BALAGTAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-633-9614
Mailing Address - Street 1:318 W BALL RD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-6049
Mailing Address - Country:US
Mailing Address - Phone:714-633-9614
Mailing Address - Fax:714-633-9617
Practice Address - Street 1:318 W BALL RD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-6049
Practice Address - Country:US
Practice Address - Phone:714-633-9614
Practice Address - Fax:714-633-9617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA452251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty