| NPI | 1922425982 |
|---|---|
| Former Name | MELISSA ALICE BALK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 32446) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS039872) |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2019-06-13 |