Provider Demographics
NPI:1639377559
Name:BALOBALO, MELODY (DDS, PROSTHODONTIST)
Entity type:Individual
Prefix:DR
First Name:MELODY
Middle Name:
Last Name:BALOBALO
Suffix:
Gender:F
Credentials:DDS, PROSTHODONTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9700 RESEDA BLVD.
Mailing Address - Street 2:SUITE 207
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-5505
Mailing Address - Country:US
Mailing Address - Phone:818-349-9040
Mailing Address - Fax:
Practice Address - Street 1:9700 RESEDA BLVD.
Practice Address - Street 2:SUITE 207
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-5505
Practice Address - Country:US
Practice Address - Phone:818-349-9040
Practice Address - Fax:818-701-7795
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA463711223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics