=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265422786
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LASZLO BALINT SR. D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2005
-----------------------------------------------------
Last Update Date | 11/19/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 916 KENMORE BLVD
-----------------------------------------------------
City | AKRON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44314-2113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-753-8155
-----------------------------------------------------
Fax | 330-753-5988
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27215 BUFFALO RD
-----------------------------------------------------
City | KENSINGTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44427-9725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-894-1106
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 20102
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------