Provider Demographics
NPI:1124618350
Name:MARIA BALTAROWICH DDS PC
Entity type:Organization
Organization Name:MARIA BALTAROWICH DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:BALTAROWICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-757-2221
Mailing Address - Street 1:4265 E 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-1578
Mailing Address - Country:US
Mailing Address - Phone:586-757-2221
Mailing Address - Fax:586-757-5903
Practice Address - Street 1:4265 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-1578
Practice Address - Country:US
Practice Address - Phone:586-757-2221
Practice Address - Fax:586-757-5903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental