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General NPI Number Information
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NPI Number | 1942613518
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Entity Type | Individual
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Provider Name | SARAH BALASTER D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/11/2014
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Last Update Date | 04/19/2024
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Provider Practice Location Address
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Address Line | 324 ELM ST STE 103A
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City | MONROE
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State | CT
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Zip | 06468-2281
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Country | US
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Telephone | 203-268-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 112-114 MAIN STREET
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City | ESOPUS
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State | NY
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Zip | 12429
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Country | US
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Telephone | 914-486-4894
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DI02569200
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License Number State | NJ
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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 | 22DI02569200
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 058626-1
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 13705
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License Number State | CT
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