Healthcare Provider Details

I. General information

NPI: 1346530102
Provider Name (Legal Business Name): TENNY BALABEGIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 05/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10028 LEONA ST
TUJUNGA CA
91042-2535
US

IV. Provider business mailing address

10028 LEONA ST
TUJUNGA CA
91042-2535
US

V. Phone/Fax

Practice location:
  • Phone: 818-399-0550
  • Fax:
Mailing address:
  • Phone: 818-399-0550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6190
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number63243
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: