Healthcare Provider Details

I. General information

NPI: 1417177114
Provider Name (Legal Business Name): BLAINE WRIGHT MCLAUGHLIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5945 COUNCIL ST NE # B
CEDAR RAPIDS IA
52402-5858
US

IV. Provider business mailing address

5945 COUNCIL ST NE # B
CEDAR RAPIDS IA
52402-5858
US

V. Phone/Fax

Practice location:
  • Phone: 319-373-5082
  • Fax: 319-373-7083
Mailing address:
  • Phone: 319-373-5082
  • Fax: 319-373-7083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7795
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1053496760
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerDENTAL TOUCH NPI #
# 2
Identifier0748509
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 3
Identifier2130047
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: