Healthcare Provider Details

I. General information

NPI: 1154245744
Provider Name (Legal Business Name): VISHAAL N BALAMURUGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 CLAIRTON BLVD
PITTSBURGH PA
15236-3808
US

IV. Provider business mailing address

5501 ROCK VALLEY WAY
LOUISVILLE KY
40241-1467
US

V. Phone/Fax

Practice location:
  • Phone: 412-650-9575
  • Fax:
Mailing address:
  • Phone: 651-253-0656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS046074
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: