Provider Demographics
NPI:1891857009
Name:BALTHAZAR, RENEE (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:
Last Name:BALTHAZAR
Suffix:
Gender:F
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 E INDIAN TRAIL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505
Mailing Address - Country:US
Mailing Address - Phone:630-859-8353
Mailing Address - Fax:
Practice Address - Street 1:243 E INDIAN TRAIL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505
Practice Address - Country:US
Practice Address - Phone:630-859-8353
Practice Address - Fax:630-896-2670
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry