Healthcare Provider Details

I. General information

NPI: 1518196013
Provider Name (Legal Business Name): JEFFREY D. BLUM, D.D.S., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 07/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4308 ALTON RD SUITE 850
MIAMI BEACH FL
33140-4556
US

IV. Provider business mailing address

4308 ALTON RD SUITE 850
MIAMI BEACH FL
33140-4556
US

V. Phone/Fax

Practice location:
  • Phone: 305-538-3446
  • Fax: 305-538-2019
Mailing address:
  • Phone: 305-538-3446
  • Fax: 305-538-2019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN5527
License Number StateFL

VIII. Authorized Official

Name: DR. JEFFREY DENNIS BLUM
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 305-538-4556