Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 4741 | TN |
NPI | 1104154939 |
---|---|
Provider Name | Dr. Frank S. Balaban |
First Address | Knoxville, TN 37919-2707 |
Second Address | Knoxville, TN 37919-2707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2009 |
Last Update Date | 07/12/2009 |