Provider Demographics
NPI:1013721216
Name:BALES AND KING ORTHODONTIC PARTNERSHIP
Entity type:Organization
Organization Name:BALES AND KING ORTHODONTIC PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BALES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:415-897-3141
Mailing Address - Street 1:1713 NOVATO BLVD
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-3014
Mailing Address - Country:US
Mailing Address - Phone:415-897-3141
Mailing Address - Fax:415-898-3445
Practice Address - Street 1:1713 NOVATO BLVD
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-3014
Practice Address - Country:US
Practice Address - Phone:415-897-3141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1770688517OtherNPI TYPE 2
CA1487153680OtherNPI TYPE 1 INDIVIDUAL
CA1760621593OtherNPI TYPE 1 INDIVIDUAL
CA942443492OtherPREVIOUS TYPE 2 NPI