Provider Demographics
NPI:1770654253
Name:MALIN, BIANCA (DDS)
Entity Type:Individual
Prefix:DR
First Name:BIANCA
Middle Name:
Last Name:MALIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 N WOLF RD
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-2735
Mailing Address - Country:US
Mailing Address - Phone:847-824-5151
Mailing Address - Fax:847-824-8981
Practice Address - Street 1:322 N WOLF RD
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-2735
Practice Address - Country:US
Practice Address - Phone:847-824-5151
Practice Address - Fax:847-824-8981
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190250721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice