Gregory Alan Balog

Primary specialty

DentistTaxonomy code 122300000X

License

13292 Issued in MI

Practice address

1049 N Macomb St
Monroe, MI 48162-3126

Phone

(734) 242-4334

Fax

(734) 242-0820

NPI assigned

Aug 1, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

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

State licenses

Practice roles

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

• Maxine Cannon DDS, PLLC

  dba Cannon Family Dental

  • General Practice Dentistry
  • Monroe, MI
  • NPI 1497562276
  NPD (past)

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1932116134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1049 N MACOMB ST",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481623126",
            "telephone_number": "734-242-4334",
            "fax_number": "734-242-0820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1049 N MACOMB ST",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481623126",
            "telephone_number": "734-242-4334",
            "fax_number": "734-242-0820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALOG",
        "first_name": "GREGORY",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "13292",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "13292",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lindsay Baker
• Tara Baldwin, CNP
• Marta Baldysz
• Jennifer Balk
• Esther Jane Ball, LPN
• Cortney Bamberger, LLMSW
• Keith Roydon Barbour, D.O.
• Redina Bardhi, MD
• Courtney Paige Barnett, PT, DPT
• Caitlyn Bartley

• Dentist in Monroe, MI
• Providers in Monroe, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.