Provider Demographics
NPI:1326545054
Name:BALACI, ALEXANDRA JORDAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:JORDAN
Last Name:BALACI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 TUCK ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7477
Mailing Address - Country:US
Mailing Address - Phone:484-269-8806
Mailing Address - Fax:
Practice Address - Street 1:1671 OREGON PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4390
Practice Address - Country:US
Practice Address - Phone:717-295-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0426251223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry