Provider Demographics
NPI:1548318660
Name:BILECA, HRISTU (DDS)
Entity type:Individual
Prefix:
First Name:HRISTU
Middle Name:
Last Name:BILECA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1666 SANDAL WOOD PL
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-1326
Mailing Address - Country:US
Mailing Address - Phone:805-492-2293
Mailing Address - Fax:
Practice Address - Street 1:1321 E THOUSAND OAKS BLVD
Practice Address - Street 2:SUITE A-112
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-2821
Practice Address - Country:US
Practice Address - Phone:805-379-4764
Practice Address - Fax:805-379-0122
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA428061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB42806-01OtherDENTI-CAL & HEALTHY FAMIL