Provider Demographics
NPI:1730392960
Name:BALANOFF, WILLIAM L (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:L
Last Name:BALANOFF
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 1:915 MIDDLE RIVER DR
Mailing Address - Street 2:SUITE 501
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3544
Mailing Address - Country:US
Mailing Address - Phone:954-566-0751
Mailing Address - Fax:954-566-1674
Practice Address - Street 1:915 MIDDLE RIVER DR
Practice Address - Street 2:SUITE 501
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3544
Practice Address - Country:US
Practice Address - Phone:954-566-0751
Practice Address - Fax:954-566-1674
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL95341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice