Provider Demographics
NPI:1811103369
Name:BALA, KRISHNAN R (D D S)
Entity type:Individual
Prefix:DR
First Name:KRISHNAN
Middle Name:R
Last Name:BALA
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8738 E WHISPERING WIND DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-2892
Mailing Address - Country:US
Mailing Address - Phone:480-628-4011
Mailing Address - Fax:
Practice Address - Street 1:10503 W THUNDERBIRD BLVD
Practice Address - Street 2:309
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3022
Practice Address - Country:US
Practice Address - Phone:623-977-6402
Practice Address - Fax:623-977-9521
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ26271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice