MEDICARE: DR. BRUCE BLUMENFELD 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	1223P0221X	Pediatric Dentistry	DS020070L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790830289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE BLUMENFELD DDS

Provider Business Mailing Address
First Line	:	2239 SHADY AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15217-2113
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1650 WALNUT ST
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17103-2350
Country	:	US
Telephone Number	:	717-230-3958
Fax Number	:

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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