Provider Demographics
NPI:1538372776
Name:VANBALEN, JOSEPH JOHN JR (DDS)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JOHN
Last Name:VANBALEN
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2344 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2335
Mailing Address - Country:US
Mailing Address - Phone:161-423-9086
Mailing Address - Fax:161-423-9088
Practice Address - Street 1:2344 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-2335
Practice Address - Country:US
Practice Address - Phone:161-423-9086
Practice Address - Fax:161-423-9088
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH141731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice