Provider Demographics
NPI:1194915025
Name:BALIGA, NARAYANI (DMD)
Entity type:Individual
Prefix:DR
First Name:NARAYANI
Middle Name:
Last Name:BALIGA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9815 MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:MD
Mailing Address - Zip Code:20872-2099
Mailing Address - Country:US
Mailing Address - Phone:301-747-6547
Mailing Address - Fax:
Practice Address - Street 1:9815 MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:MD
Practice Address - Zip Code:20872-2099
Practice Address - Country:US
Practice Address - Phone:301-747-6543
Practice Address - Fax:855-202-0720
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA21909122300000X
MD151051223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD047671400Medicaid
MD15105OtherDHMH