Individual
ALI BALOUCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
8628 VAN NUYS BLVD # 200, PANORAMA CITY, CA 91402-2913
(818) 396-3999
Mailing address
1435 ANDENES DR, GLENDALE, CA 91208-1910
(818) 396-3999
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
60521
CA
Other
Enumeration date
11/19/2019
Last updated
11/19/2019
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