Provider Demographics
NPI:1568476604
Name:BALSTER, ERIK T (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:T
Last Name:BALSTER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:450 WASHINGTON AVE UNIT 5
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-9066
Mailing Address - Country:US
Mailing Address - Phone:319-325-1064
Mailing Address - Fax:
Practice Address - Street 1:4207 GLASS RD. NE SUITE 2
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402
Practice Address - Country:US
Practice Address - Phone:319-294-8181
Practice Address - Fax:319-261-8182
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA083591223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1475392Medicaid