Healthcare Provider Details

I. General information

NPI: 1235622051
Provider Name (Legal Business Name): KRISTEN ELIZABETH BLUMBERG DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN E DREYER DMD

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 NW 27TH CT
GAINESVILLE FL
32606-6590
US

IV. Provider business mailing address

4910 NW 27TH CT
GAINESVILLE FL
32606-6590
US

V. Phone/Fax

Practice location:
  • Phone: 352-335-7777
  • Fax: 352-727-4066
Mailing address:
  • Phone: 352-335-7777
  • Fax: 352-727-4066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN23584
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: