Provider Demographics
NPI:1528235348
Name:BALICA, ANA C (DDS)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:C
Last Name:BALICA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3149 STEINWAY ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3908
Mailing Address - Country:US
Mailing Address - Phone:718-545-7175
Mailing Address - Fax:718-545-7175
Practice Address - Street 1:3149 STEINWAY ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3908
Practice Address - Country:US
Practice Address - Phone:718-545-7175
Practice Address - Fax:718-545-7175
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0453661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01491643Medicaid