| NPI | 1134467145 |
|---|---|
| Former Legal Business Name | NORTHEAST FAMILY DENTAL, LLC |
| Entity Type | Organization |
| Authorized Contact | BRUCE C. BALOY Owner 614-891-7075 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 15684) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 20715) |
| Enumeration Date | 2013-01-25 |
| Last Update Date | 2016-01-04 |