Provider Demographics
NPI:1720663487
Name:BALASANYAN AND BALASANYAN PLLC
Entity Type:Organization
Organization Name:BALASANYAN AND BALASANYAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BALASANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:980-275-0099
Mailing Address - Street 1:8200 CAESARS HEAD DR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7048
Mailing Address - Country:US
Mailing Address - Phone:980-275-0099
Mailing Address - Fax:
Practice Address - Street 1:3614 PROVIDENCE RD S STE 103
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-6310
Practice Address - Country:US
Practice Address - Phone:980-275-0099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No122300000XDental ProvidersDentistGroup - Single Specialty