Provider Demographics
NPI:1134358674
Name:BALABAN, ALEX M (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:M
Last Name:BALABAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13590 B N. MERIDIAN ST.
Mailing Address - Street 2:SUITE #101
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032
Mailing Address - Country:US
Mailing Address - Phone:317-575-1995
Mailing Address - Fax:317-575-1998
Practice Address - Street 1:13590 B N. MERIDIAN ST.
Practice Address - Street 2:SUITE #101
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032
Practice Address - Country:US
Practice Address - Phone:317-575-1995
Practice Address - Fax:317-575-1998
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010434A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200387710AMedicaid