Provider Demographics
NPI:1851943534
Name:SCIARRESI URZUA, BIANCA G (DDS)
Entity Type:Individual
Prefix:DR
First Name:BIANCA
Middle Name:G
Last Name:SCIARRESI URZUA
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 1:135 BRITTANY FARMS RD APT D
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-1127
Mailing Address - Country:US
Mailing Address - Phone:631-290-9828
Mailing Address - Fax:860-679-1363
Practice Address - Street 1:1604 VISA DR STE 3
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-2195
Practice Address - Country:US
Practice Address - Phone:309-660-9159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12577390200000X
IL019.033401122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program