Michael Hugh Balfour, D.D.S.

Key facts

NPI

1962797191

Entity type

Individual (NPI type 1)

Primary specialty

Dentist 122300000X

License

010493 (CT)

Practice address

1147 W Main St
Waterbury, CT 06708-2737

Phone

(203) 755-7541

Fax

(203) 755-1675

NPI assigned

Jun 15, 2011

Sex

Male

Sole proprietor

No

Organizations & group practices 1

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.

• West Main Family Dentistry General Practice Dentistry · Waterbury, CT · NPI 1396120390
  NPD (past) Authorized official GENERAL PRACTICE

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 19, 2016.

{
    "created_epoch": "1308096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474243200000",
    "number": "1962797191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1147 W MAIN ST",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082737",
            "telephone_number": "203-755-7541",
            "fax_number": "203-755-1675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1147 W MAIN ST",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082737",
            "telephone_number": "203-755-7541",
            "fax_number": "203-755-1675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALFOUR",
        "first_name": "MICHAEL",
        "middle_name": "HUGH",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-15",
        "last_updated": "2016-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CT",
            "license": "010493",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NH",
            "license": "03892",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008033744",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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