Provider Demographics
NPI:1902814288
Name:JAMES S BALUTES DMD PC
Entity Type:Organization
Organization Name:JAMES S BALUTES DMD PC
Other - Org Name:APPLESEED DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:BALUTIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-537-6106
Mailing Address - Street 1:136 WILDER RD
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-6644
Mailing Address - Country:US
Mailing Address - Phone:978-345-2881
Mailing Address - Fax:
Practice Address - Street 1:23 MILL ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-3243
Practice Address - Country:US
Practice Address - Phone:978-537-6106
Practice Address - Fax:978-537-9719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0253642Medicaid
MAX12273OtherBCBS