MEDICARE: ROBERT BALCH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN3707	FL

General Provider Information

NPI Number	:	1902966823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT BALCH

Provider Business Mailing Address
First Line	:	1770 N WICKHAM RD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-8122
Country	:	US
Telephone Number	:	321-773-6666
Fax Number	:

Provider Business Practice Location Address
First Line	:	1324 HIGHWAY A1A
Second Line	:
City	:	SATELLITE BEACH
State	:	FL
Zip	:	32937-2408
Country	:	US
Telephone Number	:	321-773-6666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	07/08/2007

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