Provider Demographics
NPI:1619521499
Name:BALKOVEC, AMY (RDH, PHDHP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BALKOVEC
Suffix:
Gender:F
Credentials:RDH, PHDHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 DANA CT
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-5322
Mailing Address - Country:US
Mailing Address - Phone:412-418-4104
Mailing Address - Fax:412-366-6778
Practice Address - Street 1:1108 WINDMILL LN
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-6202
Practice Address - Country:US
Practice Address - Phone:412-364-2213
Practice Address - Fax:412-366-6778
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH08202124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist