Healthcare Provider Details

I. General information

NPI: 1114079647
Provider Name (Legal Business Name): BARRY S. BLANK,D.D.S.,M.SC.D, ALAN R. LEVY D.M.D. & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5180 E MAIN ST SUITE A
COLUMBUS OH
43213-2436
US

IV. Provider business mailing address

5180 E MAIN ST SUITE A
COLUMBUS OH
43213-2436
US

V. Phone/Fax

Practice location:
  • Phone: 614-864-2561
  • Fax: 614-864-2915
Mailing address:
  • Phone: 614-864-2561
  • Fax: 614-864-2915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: BARRY S. BLANK
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 614-864-2561