Provider Demographics
NPI:1093885048
Name:BIALECKI, HUGH A (DMD)
Entity Type:Individual
Prefix:
First Name:HUGH
Middle Name:A
Last Name:BIALECKI
Suffix:
Gender:M
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:PO BOX 275
Mailing Address - Street 2:402 S. GRASS VALLEY RD
Mailing Address - City:BLUE JAY
Mailing Address - State:CA
Mailing Address - Zip Code:92317-0275
Mailing Address - Country:US
Mailing Address - Phone:909-337-0705
Mailing Address - Fax:909-337-4925
Practice Address - Street 1:402 S. GRASS VALLEY RD
Practice Address - Street 2:
Practice Address - City:LAKE ARROWHEAD
Practice Address - State:CA
Practice Address - Zip Code:92352-0000
Practice Address - Country:US
Practice Address - Phone:909-337-0705
Practice Address - Fax:909-337-4925
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0315701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice