Provider Demographics
NPI:1689734816
Name:BALAGTAS, MARIA CONCEPCION BUENAVENTURA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA CONCEPCION
Middle Name:BUENAVENTURA
Last Name:BALAGTAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 N GLASSELL
Mailing Address - Street 2:STE E
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867
Mailing Address - Country:US
Mailing Address - Phone:714-633-9614
Mailing Address - Fax:714-633-9617
Practice Address - Street 1:1330 N GLASSELL
Practice Address - Street 2:STE E
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867
Practice Address - Country:US
Practice Address - Phone:714-633-9614
Practice Address - Fax:714-633-9617
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45225122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist