Provider Demographics
NPI:1811565427
Name:BALTAZAR, CARSON JAMES (DDS)
Entity Type:Individual
Prefix:
First Name:CARSON
Middle Name:JAMES
Last Name:BALTAZAR
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 1:2951 SW WANAMAKER DR STE B
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-5320
Mailing Address - Country:US
Mailing Address - Phone:785-273-0801
Mailing Address - Fax:785-273-7350
Practice Address - Street 1:2951 SW WANAMAKER DR STE B
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-5320
Practice Address - Country:US
Practice Address - Phone:785-273-0801
Practice Address - Fax:785-273-7350
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS618541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice