Healthcare Provider Details

I. General information

NPI: 1144552043
Provider Name (Legal Business Name): BAL DENTAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 GREENBACK LN SUITE 110
CITRUS HEIGHTS CA
95621-4700
US

IV. Provider business mailing address

5959 GREENBACK LN SUITE 110
CITRUS HEIGHTS CA
95621-4700
US

V. Phone/Fax

Practice location:
  • Phone: 916-723-4777
  • Fax: 916-723-4725
Mailing address:
  • Phone: 916-723-4777
  • Fax: 916-723-4725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: DR. HARSIMRAT BAL
Title or Position: CHIEF DENTIST
Credential:
Phone: 916-723-4777