Provider Demographics
NPI:1346387362
Name:BALASANIAN, EDUARD (DDS, MD)
Entity type:Individual
Prefix:
First Name:EDUARD
Middle Name:
Last Name:BALASANIAN
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26302 LA PAZ RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5313
Mailing Address - Country:US
Mailing Address - Phone:949-586-7000
Mailing Address - Fax:949-586-0158
Practice Address - Street 1:26302 LA PAZ RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5313
Practice Address - Country:US
Practice Address - Phone:949-586-7000
Practice Address - Fax:949-586-0158
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA487021223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery