Provider Demographics
NPI:1760603351
Name:BILANCIONE, CARL D (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:D
Last Name:BILANCIONE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 CASA ALOMA WAY
Mailing Address - Street 2:SUITE 700
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2270
Mailing Address - Country:US
Mailing Address - Phone:407-678-4000
Mailing Address - Fax:407-678-4001
Practice Address - Street 1:2828 CASA ALOMA WAY
Practice Address - Street 2:SUITE 700
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2270
Practice Address - Country:US
Practice Address - Phone:407-678-4000
Practice Address - Fax:407-678-4001
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 91541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL557289OtherUNITED CONCORDIA
FL60966OtherBCBS