Provider Demographics
NPI:1154756146
Name:BALCOM, KRISTINE E (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:E
Last Name:BALCOM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2924 AVON RD
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4935
Mailing Address - Country:US
Mailing Address - Phone:916-443-8955
Mailing Address - Fax:
Practice Address - Street 1:2627 K ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5103
Practice Address - Country:US
Practice Address - Phone:916-443-8955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42031122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist