Provider Demographics
NPI:1417913336
Name:BIANCUCCI, MARA LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARA
Middle Name:LYNN
Last Name:BIANCUCCI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:PROF
Other - First Name:MARA
Other - Middle Name:LYNN
Other - Last Name:DUNLAP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:605 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15229-2723
Mailing Address - Country:US
Mailing Address - Phone:412-939-6310
Mailing Address - Fax:412-383-7862
Practice Address - Street 1:605 PERRY HWY
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15229-2723
Practice Address - Country:US
Practice Address - Phone:412-939-6310
Practice Address - Fax:412-383-7862
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030617L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1746559Medicare ID - Type UnspecifiedINDIVIDUAL PA MEDICAID