Healthcare Provider Details

I. General information

NPI: 1831194224
Provider Name (Legal Business Name): MEHDI BALAKHANI M.D., D.D.S., PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 03/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 OGLETOWN STANTON RD MAP #1, SUITE 226
NEWARK DE
19713-2067
US

IV. Provider business mailing address

4745 OGLETOWN STANTON RD MAP #1, SUITE 226
NEWARK DE
19713-2067
US

V. Phone/Fax

Practice location:
  • Phone: 302-368-8900
  • Fax: 302-368-7866
Mailing address:
  • Phone: 302-368-8900
  • Fax: 302-368-7866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC1-0002053
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: