Provider Demographics
NPI:1609116656
Name:HARBINDER BAL DMD, MSD, PS
Entity Type:Organization
Organization Name:HARBINDER BAL DMD, MSD, PS
Other - Org Name:MOUNT VERNON PERIODONTICS & IMPLANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARBINDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MSD
Authorized Official - Phone:360-424-5175
Mailing Address - Street 1:120 E FIR ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-2964
Mailing Address - Country:US
Mailing Address - Phone:360-424-5175
Mailing Address - Fax:360-424-5177
Practice Address - Street 1:120 E FIR ST STE 101
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2964
Practice Address - Country:US
Practice Address - Phone:360-424-5175
Practice Address - Fax:360-424-5177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADE00010010OtherDENTAL LICENSE