Healthcare Provider Details

I. General information

NPI: 1194647693
Provider Name (Legal Business Name): BALSAM ALHWAIDI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 HENDERSON RD STE 80
UPPER ARLINGTON OH
43220-2459
US

IV. Provider business mailing address

2025 HENDERSON RD STE 80
UPPER ARLINGTON OH
43220-2459
US

V. Phone/Fax

Practice location:
  • Phone: 614-602-5375
  • Fax:
Mailing address:
  • Phone: 614-602-5375
  • Fax: 614-602-5375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.028625
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: