Provider Demographics
NPI:1730264219
Name:BAL, ROMMEL KAUR (DDS)
Entity type:Individual
Prefix:
First Name:ROMMEL
Middle Name:KAUR
Last Name:BAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 ST MARKS PLAZA
Mailing Address - Street 2:SUITE 11
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207
Mailing Address - Country:US
Mailing Address - Phone:209-957-1244
Mailing Address - Fax:209-957-2591
Practice Address - Street 1:1545 ST MARKS PLAZA
Practice Address - Street 2:SUITE 11
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207
Practice Address - Country:US
Practice Address - Phone:209-957-1244
Practice Address - Fax:209-957-2591
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53755122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist