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General NPI Number Information
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NPI Number | 1790839629
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Entity Type | Individual
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Provider Name | AYMAN A BALSHE DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 08/11/2011
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Provider Practice Location Address
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Address Line | 2115 E VIKING AVE
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City | ANAHEIM
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State | CA
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Zip | 92806-4655
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Country | US
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Telephone | 612-805-9505
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Fax |
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Provider Business Mailing Address
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Address Line | 2115 E VIKING AVE
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City | ANAHEIM
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State | CA
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Zip | 92806-4655
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Country | US
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Telephone | 612-805-9505
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | D12354
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 57041
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License Number State | CA
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