Provider Demographics
NPI:1689556821
Name:BALZEN, JOSHUA ALLEN (DDS)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ALLEN
Last Name:BALZEN
Suffix:
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 1:2815 EASTRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-4569
Mailing Address - Country:US
Mailing Address - Phone:801-960-6106
Mailing Address - Fax:
Practice Address - Street 1:3501 N BUTLER AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-6429
Practice Address - Country:US
Practice Address - Phone:505-564-4470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDB-2025-01311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice