Provider Demographics
NPI:1063521045
Name:BALASZ, JAY E (DDS)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:E
Last Name:BALASZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-1419
Mailing Address - Country:US
Mailing Address - Phone:231-547-2377
Mailing Address - Fax:231-547-5372
Practice Address - Street 1:707 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-1419
Practice Address - Country:US
Practice Address - Phone:231-547-2377
Practice Address - Fax:231-547-5372
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010143791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice