Provider Demographics
NPI:1427315316
Name:BALICKA, JUSTYNA (DDS)
Entity type:Individual
Prefix:DR
First Name:JUSTYNA
Middle Name:
Last Name:BALICKA
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 1:2140 DOGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-6021
Mailing Address - Country:US
Mailing Address - Phone:516-805-4994
Mailing Address - Fax:
Practice Address - Street 1:124 MAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-6922
Practice Address - Country:US
Practice Address - Phone:631-423-7857
Practice Address - Fax:631-423-7858
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0567851223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty