Provider Demographics
NPI:1962676163
Name:JOHN R. BIANCALANA, DDS LTD.
Entity Type:Organization
Organization Name:JOHN R. BIANCALANA, DDS LTD.
Other - Org Name:SHAWNWAY PLAZA DENTAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BIANCALANA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-985-5552
Mailing Address - Street 1:640 MEACHAM RD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3003
Mailing Address - Country:US
Mailing Address - Phone:847-985-5552
Mailing Address - Fax:847-985-9049
Practice Address - Street 1:640 MEACHAM RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3003
Practice Address - Country:US
Practice Address - Phone:847-985-5552
Practice Address - Fax:847-985-9049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1225246929OtherINDIVIDUAL NPI