1790210292 NPI number — DR. STEVEN SPENSER BALANDRAN DDS, MD

Table of content: DR. STEVEN SPENSER BALANDRAN DDS, MD (NPI 1790210292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790210292 NPI number — DR. STEVEN SPENSER BALANDRAN DDS, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALANDRAN
Provider First Name:
STEVEN
Provider Middle Name:
SPENSER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS, MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790210292
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4185 TECHNOLOGY FOREST BLVD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THE WOODLANDS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77381-2004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-486-4052
Provider Business Mailing Address Fax Number:
713-486-4333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8687 LOUETTA RD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77379-6674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-370-4034
Provider Business Practice Location Address Fax Number:
281-374-8251
Provider Enumeration Date:
04/22/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 204E00000X , with the licence number:  38331 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223S0112X , with the licence number: 38331 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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