Provider Demographics
NPI:1649746066
Name:ROMMEL K BAL DDS A DENTAL CORPORATION
Entity Type:Organization
Organization Name:ROMMEL K BAL DDS A DENTAL CORPORATION
Other - Org Name:DIGNITY DENTAL PRACTICE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMMEL
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:BAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-957-1244
Mailing Address - Street 1:1545 SAINT MARKS PLZ STE 1
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6411
Mailing Address - Country:US
Mailing Address - Phone:209-957-1244
Mailing Address - Fax:209-957-2591
Practice Address - Street 1:1545 SAINT MARKS PLZ STE 1
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6411
Practice Address - Country:US
Practice Address - Phone:209-957-1244
Practice Address - Fax:209-957-2591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty