NPIMap

Organization Active NPI

Peter Balacky Dental Corporation

Doing business as Larchmont Village Oral Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Los Angeles, CA
National Provider Identifier
1871212738
Registry record updated Apr 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
PETER BALACKY DENTAL CORPORATION
Doing business as
Larchmont Village Oral Surgery
Practice address
321 N Larchmont Blvd Ste 613
Los Angeles, CA 90004-3051
Phone
(323) 465-6451
NPI assigned
Aug 24, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2024

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

Authorized official

Name
Dr. Peter Balacky, DDSNPI 1164881926
Title
Owner
Phone
(646) 756-9450

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X Primary

Addresses

Primary practice location

321 N Larchmont Blvd Ste 613
Los Angeles, CA 90004-3051

Mailing address

321 N Larchmont Blvd Ste 617
Los Angeles, CA 90004-6406
Phone (323) 465-6451

Other names 1

  • Larchmont Village Oral Surgery Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1661299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712016000000",
    "number": "1871212738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 N LARCHMONT BLVD STE 617",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900046406",
            "telephone_number": "323-465-6451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 N LARCHMONT BLVD STE 613",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900043051",
            "telephone_number": "323-465-6451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETER BALACKY DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-24",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A",
        "authorized_official_last_name": "BALACKY",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "646-756-9450",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Larchmont Village Oral Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2024; 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.