Provider Demographics
NPI:1780890665
Name:BALCH, HARVEY MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:MICHAEL
Last Name:BALCH
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 1:400 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95692-9442
Mailing Address - Country:US
Mailing Address - Phone:530-633-2865
Mailing Address - Fax:530-633-9491
Practice Address - Street 1:400 FRONT ST
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:CA
Practice Address - Zip Code:95692-9442
Practice Address - Country:US
Practice Address - Phone:530-633-2865
Practice Address - Fax:530-633-9491
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA199991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice