Healthcare Provider Details

I. General information

NPI: 1427617752
Provider Name (Legal Business Name): ALBA BILANI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 7TH ST E
SAINT PAUL MN
55119-3419
US

IV. Provider business mailing address

4229 25TH AVE S
MINNEAPOLIS MN
55406-3033
US

V. Phone/Fax

Practice location:
  • Phone: 651-735-0595
  • Fax:
Mailing address:
  • Phone: 612-751-6481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD14234
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: