Healthcare Provider Details

I. General information

NPI: 1417244377
Provider Name (Legal Business Name): JOSEPH MATTHEW BLONDIN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 FOX ST STE 1
POUGHKEEPSIE NY
12601-4726
US

IV. Provider business mailing address

46 FOX ST STE 1
POUGHKEEPSIE NY
12601-4726
US

V. Phone/Fax

Practice location:
  • Phone: 845-473-3636
  • Fax:
Mailing address:
  • Phone: 860-309-7672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number057231-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: