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General NPI Number Information
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NPI Number | 1164881926
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Entity Type | Individual
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Provider Name | PETER ANTHONY BALACKY DDS
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Gender | Male
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Dates
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Enumeration Date | 02/22/2016
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Last Update Date | 03/28/2024
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Provider Practice Location Address
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Address Line | 321 N LARCHMONT BLVD STE 613
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City | LOS ANGELES
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State | CA
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Zip | 90004-3051
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Country | US
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Telephone | 323-465-6451
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Fax | 323-465-6446
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Provider Business Mailing Address
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Address Line | 15332 ANTIOCH ST STE 410
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City | PACIFIC PALISADES
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State | CA
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Zip | 90272-3603
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Country | US
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Telephone | 424-322-0405
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | DEN03707
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 1666
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License Number State | WY
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Taxonomy #3
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | D012069
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | D-5590
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License Number State | ID
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Taxonomy #5
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | D11935
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License Number State | OR
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Taxonomy #6
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 22DI03009300
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License Number State | NJ
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Taxonomy #7
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | DB-2024-0028
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License Number State | NM
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Taxonomy #8
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 19034729
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License Number State | IL
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Taxonomy #9
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 016.0134252
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License Number State | VT
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Taxonomy #10
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 11062
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License Number State | KY
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Taxonomy #11
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 061045
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License Number State | NY
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Taxonomy #12
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | DEN.00205881
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License Number State | CO
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Taxonomy #13
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | DT-3154
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License Number State | HI
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Taxonomy #14
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 401418811
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License Number State | VA
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Taxonomy #15
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 107091
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License Number State | CA
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