Provider Demographics
NPI:1902970718
Name:PASALIC, AIDA (DMD)
Entity Type:Individual
Prefix:DR
First Name:AIDA
Middle Name:
Last Name:PASALIC
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 W HORTTER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2706
Mailing Address - Country:US
Mailing Address - Phone:215-991-0332
Mailing Address - Fax:
Practice Address - Street 1:1115 DEKALB PIKE
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1813
Practice Address - Country:US
Practice Address - Phone:610-278-0420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-036992122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist