Provider Demographics
NPI:1053582064
Name:BALSON, MARC
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:BALSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S LIVINGSTON AVE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4043
Mailing Address - Country:US
Mailing Address - Phone:973-994-1661
Mailing Address - Fax:973-740-8899
Practice Address - Street 1:201 S LIVINGSTON AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4043
Practice Address - Country:US
Practice Address - Phone:973-994-1661
Practice Address - Fax:973-740-8899
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI012930001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1174740567OtherORGANIZATION