MEDICARE: ALEXANDRE BALACI DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DS028132-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	449975	OTHER		AETNA
2	3905540001	OTHER	PA	CIGNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	02993801	OTHER	PA	CAPITAL BLUE CROSS
5	686413	OTHER	PA	HIGHMARK BLUE SHIELD

General Provider Information

NPI Number	:	1174514830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRE BALACI DMD

Provider Business Mailing Address
First Line	:	860 TUCK ST
Second Line	:
City	:	LEBANON
State	:	PA
Zip	:	17042-7477
Country	:	US
Telephone Number	:	717-273-6745
Fax Number	:	717-273-0009

Provider Business Practice Location Address
First Line	:	860 TUCK ST
Second Line	:
City	:	LEBANON
State	:	PA
Zip	:	17042-7477
Country	:	US
Telephone Number	:	717-273-6745
Fax Number	:	717-273-0009

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	03/16/2017

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