Provider Demographics
NPI:1790705614
Name:BIALOR, MITCHELL H (DDS)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:H
Last Name:BIALOR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11671 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-6750
Mailing Address - Country:US
Mailing Address - Phone:570-724-2542
Mailing Address - Fax:
Practice Address - Street 1:11671 ROUTE 6
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-6750
Practice Address - Country:US
Practice Address - Phone:570-724-2542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI017055001223G0001X
PADS0378141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice