Provider Demographics
NPI:1942613518
Name:BALASTER, SARAH (DMD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:
Last Name:BALASTER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112-114 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ESOPUS
Mailing Address - State:NY
Mailing Address - Zip Code:12429
Mailing Address - Country:US
Mailing Address - Phone:914-486-4894
Mailing Address - Fax:
Practice Address - Street 1:324 ELM ST STE 103A
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-2281
Practice Address - Country:US
Practice Address - Phone:203-268-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI02569200122300000X
NJ22DI025692001223P0300X
NY058626-11223P0300X
CT137051223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist