Provider Demographics
NPI:1922120377
Name:GONZALEZ BALZAR, PABLO (DDS, MS)
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:
Last Name:GONZALEZ BALZAR
Suffix:
Gender:M
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 1:9225 122ND CT NE
Mailing Address - Street 2:#K506
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5889
Mailing Address - Country:US
Mailing Address - Phone:617-642-3932
Mailing Address - Fax:
Practice Address - Street 1:5723 NE BOTHELL WAY
Practice Address - Street 2:STE C
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-9404
Practice Address - Country:US
Practice Address - Phone:425-486-9111
Practice Address - Fax:425-489-1923
Is Sole Proprietor?:No
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE106941223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics