Provider Demographics
NPI:1285103291
Name:BALKOS, JACOB CHRISTOPHER (BSC, DDS)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:CHRISTOPHER
Last Name:BALKOS
Suffix:
Gender:M
Credentials:BSC, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6756 POSS RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-2258
Mailing Address - Country:US
Mailing Address - Phone:210-680-7841
Mailing Address - Fax:210-680-3503
Practice Address - Street 1:6756 POSS RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-2258
Practice Address - Country:US
Practice Address - Phone:201-680-7841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXETN5261223P0221X
TX349691223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry