# PETER BALACKY DENTAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Larchmont Village Oral Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871212738
- **Authorized official:** DR. PETER BALACKY DDS (OWNER)
- **Authorized official phone:** (646) 756-9450

## Contact information

- **Practice address:** 321 N LARCHMONT BLVD STE 613, LOS ANGELES, CA 90004-3051
- **Practice address phone:** (323) 465-6451
- **Mailing address:** 321 N LARCHMONT BLVD STE 617, LOS ANGELES, CA 90004-6406
- **Mailing address phone:** (323) 465-6451

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 08/24/2022
- **Last updated:** 04/02/2024