John W Balaban, DDS
Individual provider Active NPI General Practice Dentistry · Gary, WV
NPI 1992887392 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1992887392
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 1793 (WV)
- Practice address
- Route 103, Supply St
Gary, WV 24836 - Phone
- (304) 448-2101
- Fax
- (304) 448-3217
- NPI assigned
- Oct 19, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1793 | WV | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tug River Health Association, Inc | Past | Accepting new patients | |
| Tug River Health Association, Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 1793 | WV | Yes |
Addresses
Primary practice location
Route 103, Supply St
Gary, WV 24836
Mailing address
PO Box 108
Greensboro, PA 15338-0108
Phone (724) 943-3412
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4001085000 | Medicaid | WV |
Other providers in Gary, WV
All providers in Gary, WV · General Practice Dentistry in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.