Mia Balsom, DMD
Individual provider Active NPI Dentist · Keene, NH
NPI 1124637301 · NPPES record last updated Jul 23, 2020
Key facts
- NPI
- 1124637301
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 04577 (NH)
- Practice address
- 342 Winchester St
Keene, NH 03431-3936 - Phone
- (844) 301-8203
- NPI assigned
- Jul 23, 2020
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04577 | NH | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 04577 | NH | Yes |
Addresses
Primary practice location
342 Winchester St
Keene, NH 03431-3936
Mailing address
222 West St Unit A401
Keene, NH 03431-2458
Other providers in Keene, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 23, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.