Provider Demographics
NPI:1801063763
Name:BALACHANDRAN, NATHERA (DDS)
Entity type:Individual
Prefix:DR
First Name:NATHERA
Middle Name:
Last Name:BALACHANDRAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:NADIA
Other - Middle Name:
Other - Last Name:BALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:3640 KIM CT
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-6208
Mailing Address - Country:US
Mailing Address - Phone:734-846-1900
Mailing Address - Fax:
Practice Address - Street 1:3640 KIM CT
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-6208
Practice Address - Country:US
Practice Address - Phone:734-846-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56978122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist