Provider Demographics
NPI:1790708139
Name:BALEKJIAN, GREGORY STEPHEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:STEPHEN
Last Name:BALEKJIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19075 NW TANASBOURNE DR
Mailing Address - Street 2:STE. 300
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5860
Mailing Address - Country:US
Mailing Address - Phone:503-531-1700
Mailing Address - Fax:
Practice Address - Street 1:19075 NW TANASBOURNE DR
Practice Address - Street 2:STE. 300
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5860
Practice Address - Country:US
Practice Address - Phone:503-531-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD67661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice