# JORDAN J BALVICH, DMD, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841458916
- **Authorized official:** DR. JORDAN J BALVICH D.M.D. (PRESIDENT)
- **Authorized official phone:** (219) 866-8110

## Contact information

- **Practice address:** 129 N VAN RENSSELAER ST, RENSSELAER, IN 47978-2651
- **Practice address phone:** (219) 866-8110
- **Practice address fax:** (219) 866-8332
- **Mailing address:** 129 N VAN RENSSELAER ST, RENSSELAER, IN 47978-2651
- **Mailing address phone:** (219) 866-8110
- **Mailing address fax:** (219) 866-8332

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 12009540A | IN | Yes |

## Other

- **Enumeration date:** 05/27/2008
- **Last updated:** 05/27/2008