Provider Demographics
NPI:1588137293
Name:MAGALLANES, BIANCA LILLIAN (DDS)
Entity type:Individual
Prefix:DR
First Name:BIANCA
Middle Name:LILLIAN
Last Name:MAGALLANES
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 1:619 PALO ALTO DR
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-7320
Mailing Address - Country:US
Mailing Address - Phone:909-534-4240
Mailing Address - Fax:
Practice Address - Street 1:330 E 4TH ST
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-2229
Practice Address - Country:US
Practice Address - Phone:951-940-5855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103427122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty