Provider Demographics
NPI:1871758128
Name:BALTAROWICH, MARIA ANNA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ANNA
Last Name:BALTAROWICH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4265 E 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-1578
Mailing Address - Country:US
Mailing Address - Phone:586-757-2221
Mailing Address - Fax:586-757-5903
Practice Address - Street 1:4265 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-1578
Practice Address - Country:US
Practice Address - Phone:586-757-2221
Practice Address - Fax:586-757-5903
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901015119122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist