Balden Gallo Michels Prof Dental Corp

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

31040 Issued in CA

Legal business name

BALDEN GALLO MICHELS PROF DENTAL CORP

Doing business as

South Bay Chula Vista Family Dental

Practice address

290 Landis Ave
Suite a & B
Chula Vista, CA 91910-2636

Phone

(619) 691-0121

Fax

(619) 691-0841

NPI assigned

Aug 25, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nicole Reid

Title

Regional Manager

Phone

(619) 261-1670

Specialties & licenses 1

Addresses

Other names 1

• South Bay Chula Vista Family Dental Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ana Beatriz Dominguez, DDS

  • General Practice Dentistry
  • Chula Vista, CA
  • NPI 1275640989
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1427166057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "290 LANDIS AVE",
            "address_2": "SUITE A & B",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919102636",
            "telephone_number": "619-691-0121",
            "fax_number": "619-691-0841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 LANDIS AVE",
            "address_2": "SUITE A & B",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919102636",
            "telephone_number": "619-691-0121",
            "fax_number": "619-691-0841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALDEN GALLO MICHELS PROF DENTAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "REID",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "REGIONAL MANAGER",
        "authorized_official_telephone_number": "619-261-1670"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "31040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Bay Chula Vista Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jade Isabel Balam
• Zuleica Ines Balam
• Balance and Bloom Family Therapy Inc. (Balance and Bloom Therapy)
• Angelica Mae Balbuena
• Ashley Elizabeth Balcazar-Medina
• Christine Yvonne Balderas, P.T.
• Rodolfo Balderas
• Analicia Baldonado, PA-C
• Krystin Ashley Baldwin
• Courtney Leigh Bale, OTR/L

• General Practice Dentistry in Chula Vista, CA
• Providers in Chula Vista, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.