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General NPI Number Information
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NPI Number | 1841458916
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Entity Type | Organization
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Legal Business Name | JORDAN J BALVICH, DMD, PC
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Dates
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Enumeration Date | 05/27/2008
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 129 N VAN RENSSELAER ST
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City | RENSSELAER
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State | IN
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Zip | 47978-2651
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Country | US
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Telephone | 219-866-8110
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Fax | 219-866-8332
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Provider Business Mailing Address
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Address Line | 129 N VAN RENSSELAER ST
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City | RENSSELAER
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State | IN
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Zip | 47978-2651
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Country | US
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Telephone | 219-866-8110
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Fax | 219-866-8332
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JORDAN J BALVICH
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Credential | D.M.D.
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Telephone | 219-866-8110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 12009540A
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License Number State | IN
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