Provider Demographics
NPI:1780082461
Name:BALASANYAN & ASSOCIATES PLLC
Entity type:Organization
Organization Name:BALASANYAN & ASSOCIATES PLLC
Other - Org Name:<UNAVAIL>
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:
Authorized Official - Phone:704-347-2557
Mailing Address - Street 1:300 BILLINGSLEY RD STE 202
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-3092
Mailing Address - Country:US
Mailing Address - Phone:704-347-2557
Mailing Address - Fax:
Practice Address - Street 1:5922 WEDDINGTON-MONROE RD
Practice Address - Street 2:SUITE A2
Practice Address - City:WESLEY CHAPEL
Practice Address - State:NC
Practice Address - Zip Code:28104
Practice Address - Country:US
Practice Address - Phone:704-843-5757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8256122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty