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NPI Code Detail

MEDICARE: CLARA E. BALANCIO, DDS, INC.

MEDICARE: CLARA E. BALANCIO, DDS, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry49040CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11083735831OTHERCANPI

General Provider Information

NPI Number : 1760672588
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLARA E. BALANCIO, DDS, INC.
Provider Business Mailing Address
First Line : 2809 REDWOOD PKWY
Second Line :
City : VALLEJO
State : CA
Zip : 94591-3634
Country : US
Telephone Number : 707-643-2273
Fax Number :
Provider Business Practice Location Address
First Line : 2809 REDWOOD PKWY
Second Line :
City : VALLEJO
State : CA
Zip : 94591-3634
Country : US
Telephone Number : 707-643-2273
Fax Number :
Authorized Official
Title or Position : DOCTOR
Name : DR. CLARA ESPINOZA BALANCIO
Credential : DDS
Telephone Number : 707-643-2273
Provider Enumeration Date : 07/27/2007
Last Update Date : 07/27/2007

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