Individual
ALEXANDRE BALACI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
860 TUCK ST, LEBANON, PA 17042-7477
(717) 273-6745
(717) 273-0009
Mailing address
860 TUCK ST, LEBANON, PA 17042-7477
(717) 273-6745
(717) 273-0009
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS028132-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0014196710001
—
PA
01
—
02993801
CAPITAL BLUE CROSS
PA
01
—
3905540001
CIGNA
PA
01
—
449975
AETNA
—
01
—
686413
HIGHMARK BLUE SHIELD
PA
Enumeration date
11/02/2005
Last updated
03/16/2017
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