Provider Demographics
NPI:1639394430
Name:BALYTSKY, OREST M (DMD)
Entity Type:Individual
Prefix:DR
First Name:OREST
Middle Name:M
Last Name:BALYTSKY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1436 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-6697
Mailing Address - Country:US
Mailing Address - Phone:707-763-2170
Mailing Address - Fax:707-763-7077
Practice Address - Street 1:1436 PROFESSIONAL DR
Practice Address - Street 2:SUITE 304
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-6697
Practice Address - Country:US
Practice Address - Phone:707-763-2170
Practice Address - Fax:707-763-7077
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA521841223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics