Provider Demographics
NPI:1518067370
Name:BIALICK, RICHARD B (PHD, DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
Last Name:BIALICK
Suffix:
Gender:M
Credentials:PHD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8950 VILLA LA JOLLA DR
Mailing Address - Street 2:SUITE B220
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1714
Mailing Address - Country:US
Mailing Address - Phone:858-453-0050
Mailing Address - Fax:858-453-0550
Practice Address - Street 1:8950 VILLA LA JOLLA DR
Practice Address - Street 2:SUITE B220
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1714
Practice Address - Country:US
Practice Address - Phone:858-453-0050
Practice Address - Fax:858-453-0550
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA335511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice