Provider Demographics
NPI:1699159392
Name:BALASANYAN, ANAIT
Entity type:Individual
Prefix:
First Name:ANAIT
Middle Name:
Last Name:BALASANYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5922 WEDDINGTON-MONROE RD.
Mailing Address - Street 2:STE A-2
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:NC
Mailing Address - Zip Code:28104
Mailing Address - Country:US
Mailing Address - Phone:704-843-5757
Mailing Address - Fax:
Practice Address - Street 1:5922 WEDDINGTON-MONROE RD.
Practice Address - Street 2:STE A-2
Practice Address - City:WESLEY CHAPEL
Practice Address - State:NC
Practice Address - Zip Code:28104
Practice Address - Country:US
Practice Address - Phone:704-843-5757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice