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General NPI Number Information
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NPI Number | 1760770473
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Entity Type | Individual
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Provider Name | MATTHEW BALASCO DDS
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Gender | Male
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Dates
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Enumeration Date | 07/14/2011
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Last Update Date | 09/11/2023
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Provider Practice Location Address
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Address Line | 1525 ELECTION HOUSE RD NW
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City | LANCASTER
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State | OH
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Zip | 43130-9041
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Country | US
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Telephone | 740-687-5900
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Fax |
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Provider Business Mailing Address
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Address Line | 1525 ELECTION HOUSE RD NW
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City | LANCASTER
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State | OH
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Zip | 43130-9041
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Country | US
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Telephone | 740-687-5900
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 30-023228
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License Number State | OH
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