Provider Demographics
NPI:1851550420
Name:BALBO, FREDERICK (DMD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:
Last Name:BALBO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-2022
Mailing Address - Country:US
Mailing Address - Phone:201-505-1830
Mailing Address - Fax:
Practice Address - Street 1:512 WINDSOR RD
Practice Address - Street 2:
Practice Address - City:WOOD RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07075-1220
Practice Address - Country:US
Practice Address - Phone:201-939-6424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-08
Last Update Date:2008-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI161661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice