Individual
JOHN W BALABAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
ROUTE 103, SUPPLY ST, GARY, WV 24836
(304) 448-2101
(304) 448-3217
Mailing address
PO BOX 108, GREENSBORO, PA 15338-0108
(724) 943-3412
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1793
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4001085000
—
WV
Enumeration date
10/19/2006
Last updated
07/08/2007
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