Individual
BALARAM KOLASANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1160 EL PASEO RD, LAS CRUCES, NM 88001-6045
(575) 652-3084
Mailing address
2225 BEX ST APT L, LAS CRUCES, NM 88005-3375
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6001150-15
WI
1223G0001X
General Practice Dentistry
DD5648
NM
Other
Enumeration date
08/01/2022
Last updated
04/20/2023
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