Healthcare Provider Details

I. General information

NPI: 1215922992
Provider Name (Legal Business Name): NORMAN BRUCE BLAUM DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8076 SPRING RUN DR
FAIRHOPE AL
36532-3854
US

IV. Provider business mailing address

8076 SPRING RUN DR
FAIRHOPE AL
36532-3854
US

V. Phone/Fax

Practice location:
  • Phone: 251-232-1083
  • Fax: 866-291-0167
Mailing address:
  • Phone: 251-232-1083
  • Fax: 866-291-0167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4072
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: