Provider Demographics
NPI:1942474879
Name:RAVI BALU DMD PC
Entity Type:Organization
Organization Name:RAVI BALU DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-628-9340
Mailing Address - Street 1:210 LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-3869
Mailing Address - Country:US
Mailing Address - Phone:724-628-9340
Mailing Address - Fax:724-628-4090
Practice Address - Street 1:210 LAUREL DR
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-3869
Practice Address - Country:US
Practice Address - Phone:724-628-9340
Practice Address - Fax:724-628-4090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027029L122300000X
PADS015819L122300000X
PADS037382122300000X
PADS031148L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty