Provider Demographics
NPI:1174514830
Name:BALACI, ALEXANDRE (DMD)
Entity type:Individual
Prefix:
First Name:ALEXANDRE
Middle Name:
Last Name:BALACI
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 1:860 TUCK ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7477
Mailing Address - Country:US
Mailing Address - Phone:717-273-6745
Mailing Address - Fax:717-273-0009
Practice Address - Street 1:860 TUCK ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7477
Practice Address - Country:US
Practice Address - Phone:717-273-6745
Practice Address - Fax:717-273-0009
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028132-L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
449975OtherAETNA
PA3905540001OtherCIGNA
PA0014196710001Medicaid
PA02993801OtherCAPITAL BLUE CROSS
PA686413OtherHIGHMARK BLUE SHIELD
PA686413OtherHIGHMARK BLUE SHIELD
PA3905540001OtherCIGNA