Provider Demographics
NPI:1427062421
Name:DEL BALSO, JAMES M (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:DEL BALSO
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 1:2300 N. MAYFAIR RD
Mailing Address - Street 2:#1040
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1555
Mailing Address - Country:US
Mailing Address - Phone:414-774-4222
Mailing Address - Fax:414-774-5007
Practice Address - Street 1:2300 N MAYFAIR RD
Practice Address - Street 2:#1040
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1505
Practice Address - Country:US
Practice Address - Phone:414-774-4222
Practice Address - Fax:414-774-5007
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50011691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice