Provider Demographics
NPI:1669644084
Name:BALIAN FAMILY DENTAL
Entity Type:Organization
Organization Name:BALIAN FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:BALIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-347-5554
Mailing Address - Street 1:741 SOUTHBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-1311
Mailing Address - Country:US
Mailing Address - Phone:508-721-7720
Mailing Address - Fax:508-721-7762
Practice Address - Street 1:741 SOUTHBRIDGE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-1311
Practice Address - Country:US
Practice Address - Phone:508-721-7720
Practice Address - Fax:508-721-7762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA194841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty