Provider Demographics
NPI:1225230022
Name:BIANCHIN, JOHN THOMAS (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:BIANCHIN
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 1:73640 EL PASEO
Mailing Address - Street 2:SUITE 9
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-4340
Mailing Address - Country:US
Mailing Address - Phone:760-776-4525
Mailing Address - Fax:760-776-4575
Practice Address - Street 1:73640 EL PASEO
Practice Address - Street 2:SUITE 9
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4340
Practice Address - Country:US
Practice Address - Phone:760-776-4525
Practice Address - Fax:760-776-4575
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53346122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist