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General NPI Number Information
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NPI Number | 1598922247
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Entity Type | Organization
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Legal Business Name | BALSTER PEDIATRIC DENTISTRY, PC
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 4207 GLASS RD NE STE 2
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City | CEDAR RAPIDS
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State | IA
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Zip | 52402-2538
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Country | US
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Telephone | 319-294-8181
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Fax | 319-261-8182
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Provider Business Mailing Address
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Address Line | 4207 GLASS RD NE STE 2
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City | CEDAR RAPIDS
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State | IA
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Zip | 52402-2538
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Country | US
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Telephone | 319-294-8181
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Fax | 319-261-8182
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Authorized Official
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Title or Position | OWNER
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Name | DR. ERIK THOMAS BALSTER
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Credential | DDS
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Telephone | 319-294-8181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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