Individual
ERICA BALBUENA TAPIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
120 W MARTIN LUTHER KING JR DR, WASHINGTON, NC 27889-4906
(252) 940-0602
Mailing address
PO BOX 113, FALKLAND, NC 27827-0113
(252) 227-3187
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11091
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11091
DENTAL LICENSE
NC
Enumeration date
06/22/2018
Last updated
06/22/2018
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