Provider Demographics
NPI:1366597916
Name:BALAKUMAR, ARUN (DDS)
Entity type:Individual
Prefix:DR
First Name:ARUN
Middle Name:
Last Name:BALAKUMAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 GRANT BLVD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13208-3014
Mailing Address - Country:US
Mailing Address - Phone:315-472-3414
Mailing Address - Fax:315-472-4320
Practice Address - Street 1:1500 GRANT BLVD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13208-3014
Practice Address - Country:US
Practice Address - Phone:315-472-3414
Practice Address - Fax:315-472-4320
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0511411223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02561315Medicaid