Organization
PETER BALACKY DENTAL CORPORATION
Active
Other names
Larchmont Village Oral Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER BALACKY DDS (OWNER)
(646) 756-9450
Entity
Organization
Contact information
Practice address
321 N LARCHMONT BLVD STE 613, LOS ANGELES, CA 90004-3051
(323) 465-6451
Mailing address
321 N LARCHMONT BLVD STE 617, LOS ANGELES, CA 90004-6406
(323) 465-6451
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
08/24/2022
Last updated
04/02/2024
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