Provider Demographics
NPI:1265574743
Name:BIALOBOK, JOSEPH S (DMD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:S
Last Name:BIALOBOK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 838
Mailing Address - Street 2:22 BROADWAY
Mailing Address - City:FONDA
Mailing Address - State:NY
Mailing Address - Zip Code:12068
Mailing Address - Country:US
Mailing Address - Phone:518-853-3618
Mailing Address - Fax:518-853-4491
Practice Address - Street 1:22 BROADWAY
Practice Address - Street 2:
Practice Address - City:FONDA
Practice Address - State:NY
Practice Address - Zip Code:12068
Practice Address - Country:US
Practice Address - Phone:518-853-3618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03297811223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics