Provider Demographics
NPI:1942730254
Name:BALDA, JOSEPH D (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:D
Last Name:BALDA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 N HENRIETTA ST
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-1772
Mailing Address - Country:US
Mailing Address - Phone:217-342-3411
Mailing Address - Fax:217-347-6559
Practice Address - Street 1:911 N HENRIETTA ST
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-1772
Practice Address - Country:US
Practice Address - Phone:217-342-3411
Practice Address - Fax:217-347-6559
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190311731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice