MEDICARE: GARY BLANKSTEIN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30337	CA

General Provider Information

NPI Number	:	1730239674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY BLANKSTEIN DDS

Provider Business Mailing Address
First Line	:	8930 S SEPULVEDA BLVD
Second Line	:	SUITE 118
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3606
Country	:	US
Telephone Number	:	310-645-6033
Fax Number	:	310-410-0990

Provider Business Practice Location Address
First Line	:	8930 S SEPULVEDA BLVD
Second Line	:	SUITE 118
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3606
Country	:	US
Telephone Number	:	310-645-6033
Fax Number	:	310-410-0990

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	07/08/2007

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Directions to “ GARY BLANKSTEIN DDS” Practice Location

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