Carrel D Balderston Jr., DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

42119 Issued in CA

Practice address

1074 East Ave Ste U
Chico, CA 95926-1052

Phone

(530) 342-8580

Fax

(530) 873-2104

NPI assigned

Jul 14, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Sam Dean Balderston Professional name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Feather River Tribal Health Inc

  • Federally Qualified Health Center (FQHC)
  • Oroville, CA
  • NPI 1629130240
  Medicare reassignment NPD
• Carrel Balderston DDS Inc

  • Dental Clinic/Center
  • Chico, CA
  • NPI 1144766528
  NPD (past)

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

{
    "created_epoch": "1184371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644364800000",
    "number": "1750580288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1074 EAST AVE STE U",
            "city": "CHICO",
            "state": "CA",
            "postal_code": "959261052",
            "telephone_number": "530-342-8580",
            "fax_number": "530-873-2104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1074 EAST AVE STE U",
            "city": "CHICO",
            "state": "CA",
            "postal_code": "959261052",
            "telephone_number": "530-342-8580",
            "fax_number": "530-873-2104"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2145 5TH AVE",
            "address_purpose": "LOCATION",
            "city": "OROVILLE",
            "state": "CA",
            "postal_code": "959655870",
            "country_code": "US",
            "telephone_number": "530-534-5394 x264",
            "fax_number": "530-534-3820",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1074 East Ave Ste U",
            "address_purpose": "LOCATION",
            "city": "Chico",
            "state": "CA",
            "postal_code": "959261052",
            "country_code": "US",
            "telephone_number": "530-342-8580",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BALDERSTON",
        "first_name": "CARREL",
        "middle_name": "D",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-14",
        "last_updated": "2022-02-09",
        "certification_date": "2022-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "42119",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "42119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAM",
            "last_name": "BALDERSTON",
            "middle_name": "DEAN",
            "credential": "D.D.S.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Caylan Bakkie, LMFT
• Jerry Donald Bakus, MS MFT
• Vincent Frank Balardi
• Balboa Island, LLC
• Nikki Emilia Balboa
• Mark Lane Balen, MFT
• Lucinda Jean Balgooyen, CHT
• Jennifer Ballintine, RDN
• Erica Lucille Baltezore, LMFT
• Gabrielle Banathy-Sullivan, LCSW

• General Practice Dentistry in Chico, CA
• Providers in Chico, 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 Feb 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.