Provider Demographics
NPI:1164658506
Name:BALAZE, DANIEL BRIAN (DMD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:BRIAN
Last Name:BALAZE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N ROBERTSON BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1789
Mailing Address - Country:US
Mailing Address - Phone:310-275-4491
Mailing Address - Fax:216-464-8638
Practice Address - Street 1:250 N ROBERTSON BLVD STE 401
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1789
Practice Address - Country:US
Practice Address - Phone:310-275-4491
Practice Address - Fax:216-464-8638
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64277122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist