Provider Demographics
NPI:1376771345
Name:BIASIELLO, FRED PETER III (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:PETER
Last Name:BIASIELLO
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:605 E ALGONQUIN RD
Mailing Address - Street 2:STE 300
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-4373
Mailing Address - Country:US
Mailing Address - Phone:847-640-1112
Mailing Address - Fax:847-510-0548
Practice Address - Street 1:5445 GRAND AVE
Practice Address - Street 2:STE 202
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-1725
Practice Address - Country:US
Practice Address - Phone:847-244-2775
Practice Address - Fax:847-244-2777
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
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Provider Licenses
StateLicense IDTaxonomies
IL0190279651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice