Provider Demographics
NPI:1871520130
Name:BALACHANDRAN, SUKUMAR (DMD)
Entity type:Individual
Prefix:
First Name:SUKUMAR
Middle Name:
Last Name:BALACHANDRAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6103 WESTCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3535
Mailing Address - Country:US
Mailing Address - Phone:410-542-0533
Mailing Address - Fax:
Practice Address - Street 1:2328 W JOPPA RD
Practice Address - Street 2:SUITE 102
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4612
Practice Address - Country:US
Practice Address - Phone:410-296-8050
Practice Address - Fax:410-296-8052
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD120521223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics