Healthcare Provider Details

I. General information

NPI: 1619073616
Provider Name (Legal Business Name): AREK BALCI D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 08/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16440 VANOWEN ST
LAKE BALBOA CA
91406-4729
US

IV. Provider business mailing address

16440 VANOWEN ST
LAKE BALBOA CA
91406-4729
US

V. Phone/Fax

Practice location:
  • Phone: 818-779-4900
  • Fax: 818-465-2753
Mailing address:
  • Phone: 818-779-4900
  • Fax: 818-465-2753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number42632
License Number StateCA

VIII. Authorized Official

Name: DR. AREK BALCI
Title or Position: OWNER
Credential: D.D.S.
Phone: 818-779-4900