Provider Demographics
NPI:1487722567
Name:LISA BALCERAK, DDS, PC
Entity type:Organization
Organization Name:LISA BALCERAK, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:V
Authorized Official - Last Name:BALCERAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-865-1484
Mailing Address - Street 1:1600 WESTCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-4362
Mailing Address - Country:US
Mailing Address - Phone:708-865-1484
Mailing Address - Fax:708-865-1866
Practice Address - Street 1:1600 WESTCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-4362
Practice Address - Country:US
Practice Address - Phone:708-865-1484
Practice Address - Fax:708-865-1866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty