Provider Demographics
NPI:1902816580
Name:BIALY, ALEXANDRA M (DDS)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:M
Last Name:BIALY
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 1:320 JENNIFER LN
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172
Mailing Address - Country:US
Mailing Address - Phone:847-987-4501
Mailing Address - Fax:
Practice Address - Street 1:1375 E SCHAUMBURG RD
Practice Address - Street 2:SUITE 330
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-5166
Practice Address - Country:US
Practice Address - Phone:847-985-9322
Practice Address - Fax:847-985-9503
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021002037(19025777)1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery