Individual
DR. TOMAS JOSE BALLESTEROS IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
64 S 23RD ST, KENILWORTH, NJ 07033-1630
(339) 221-1551
Mailing address
64 S 23RD ST, KENILWORTH, NJ 07033-1630
(339) 221-1551
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
50 054337
NY
Other
Enumeration date
05/01/2009
Last updated
05/01/2009
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