Provider Demographics
NPI:1861877227
Name:BALICE, PIERLUIGI (DDS, MDENTSC)
Entity type:Individual
Prefix:
First Name:PIERLUIGI
Middle Name:
Last Name:BALICE
Suffix:
Gender:M
Credentials:DDS, MDENTSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 GRAND BLVD APT 2014
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64106-2986
Mailing Address - Country:US
Mailing Address - Phone:860-957-7656
Mailing Address - Fax:
Practice Address - Street 1:650 E 25TH ST # 277
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2716
Practice Address - Country:US
Practice Address - Phone:816-235-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180430961223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics