Individual
DR. LONNI BALISKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
4212 N 16TH ST, PHOENIX, AZ 85016-5319
(602) 263-1200
(602) 200-5383
Mailing address
4212 N 16TH ST, PHOENIX, AZ 85016-5319
(602) 263-1200
(602) 200-5383
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D2499
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0472190
BCBS
AZ
05
—
513524
—
AZ
Enumeration date
10/04/2006
Last updated
07/25/2011
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