Individual
MIA BALSOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
342 WINCHESTER ST, KEENE, NH 03431-3936
(844) 301-8203
Mailing address
222 WEST ST UNIT A401, KEENE, NH 03431-2458
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
04577
NH
Other
Enumeration date
07/23/2020
Last updated
07/23/2020
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