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General NPI Number Information
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NPI Number | 1720663487
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Entity Type | Organization
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Legal Business Name | BALASANYAN AND BALASANYAN PLLC
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Dates
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Enumeration Date | 03/15/2021
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Last Update Date | 03/15/2021
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Provider Practice Location Address
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Address Line | 3614 PROVIDENCE RD S STE 103
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City | WAXHAW
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State | NC
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Zip | 28173-6310
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Country | US
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Telephone | 980-275-0099
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Fax |
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Provider Business Mailing Address
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Address Line | 8200 CAESARS HEAD DR
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City | WAXHAW
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State | NC
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Zip | 28173-7048
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Country | US
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Telephone | 980-275-0099
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. ARMEN BALASANYAN
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Credential | DDS
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Telephone | 980-275-0099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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