Provider Demographics
NPI:1578629143
Name:BALATGEK FAMILY DENTAL, LLC
Entity Type:Organization
Organization Name:BALATGEK FAMILY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BALATGEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-678-2777
Mailing Address - Street 1:803 MOUNTAIN HOME RD
Mailing Address - Street 2:
Mailing Address - City:SINKING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:19608-9319
Mailing Address - Country:US
Mailing Address - Phone:610-678-2777
Mailing Address - Fax:
Practice Address - Street 1:803 MOUNTAIN HOME RD
Practice Address - Street 2:
Practice Address - City:SINKING SPRING
Practice Address - State:PA
Practice Address - Zip Code:19608-9319
Practice Address - Country:US
Practice Address - Phone:610-678-2777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030170L261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental