Provider Demographics
NPI:1578713202
Name:DALIA BALAL
Entity Type:Organization
Organization Name:DALIA BALAL
Other - Org Name:WEST PARK DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCRAITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-977-6917
Mailing Address - Street 1:6400 WESTPARK,
Mailing Address - Street 2:SUITE 325
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057
Mailing Address - Country:US
Mailing Address - Phone:713-977-6717
Mailing Address - Fax:713-977-4596
Practice Address - Street 1:6400 WESTPARK,
Practice Address - Street 2:SUITE 325
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057
Practice Address - Country:US
Practice Address - Phone:713-977-6717
Practice Address - Fax:713-977-4596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2009-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15189302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization