Provider Demographics
NPI:1326141292
Name:BRSCIC-BIASI, ALIDA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALIDA
Middle Name:
Last Name:BRSCIC-BIASI
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 1:545 W. 9TH STREET
Mailing Address - Street 2:SUITE #3
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3131
Mailing Address - Country:US
Mailing Address - Phone:310-514-2717
Mailing Address - Fax:310-514-2717
Practice Address - Street 1:545 W. 9TH ST
Practice Address - Street 2:SUITE #3
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3131
Practice Address - Country:US
Practice Address - Phone:310-514-2717
Practice Address - Fax:310-514-2717
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA360561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA36056OtherCALIFORNIA LICENSE NUMBER