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General NPI Number Information
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NPI Number | 1396665964
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Entity Type | Individual
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Provider Name | DR. FADIA SALEM BAZINA
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Gender | Female
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Dates
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Enumeration Date | 07/15/2026
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Last Update Date | 07/15/2026
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Provider Practice Location Address
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Address Line | 2800 COLLEGE AVE
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City | ALTON
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State | IL
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Zip | 62002-4742
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Country | US
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Telephone | 618-474-7052
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Fax |
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Provider Business Mailing Address
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Address Line | 90 MAGNOLIA DR UNIT 1209
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City | GLEN CARBON
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State | IL
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Zip | 62034-1589
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Country | US
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Telephone | 404-903-3068
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 019.037046
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License Number State | IL
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