Provider Demographics
NPI:1245445964
Name:BALAKRISHNAN, MEENAKSHI (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:MEENAKSHI
Middle Name:
Last Name:BALAKRISHNAN
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 NORTH HARBOR DRIVE
Mailing Address - Street 2:#1304
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7528
Mailing Address - Country:US
Mailing Address - Phone:630-515-2727
Mailing Address - Fax:419-735-6033
Practice Address - Street 1:1330 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-2772
Practice Address - Country:US
Practice Address - Phone:630-515-2727
Practice Address - Fax:419-735-6033
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics