Dr. Leszek Adam Balla, D.D.S.
Dentist in Maywood, IL. Individual provider (NPI-1).
NPI number1346364411
StatusActive
Last updated in NPPESApr 21, 2021
Details
- NPI
- 1346364411
- Entity type
- Individual (NPI-1)
- Name
- Dr. Leszek Adam Balla
- Credential
- D.D.S.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 16, 2007
- Certification date
- Apr 21, 2021
- Last updated
- Apr 21, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 019-017066 | IL | Yes |
| 1223G0001X | Dentist, General Practice | 019-017066 | IL | |
| 1223G0001X | Dentist, General Practice | 2604-015 | WI |
Practice location
1701 S 1st AveSuite 102
Maywood, IL 60153-2442
Phone 708-450-5300
Mailing address
3638 Crain StSkokie, IL 60076-2352
Phone 847-329-0972
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