Healthcare Provider Details

I. General information

NPI: 1467504985
Provider Name (Legal Business Name): BARRY S. BLANK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
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 Number13437
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: