Healthcare Provider Details

I. General information

NPI: 1558080127
Provider Name (Legal Business Name): 614 SMILES, VICTORIA BLEM, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4490 INDIANOLA AVE
COLUMBUS OH
43214-2244
US

IV. Provider business mailing address

6092 HERITAGE FARMS DR
HILLIARD OH
43026-7958
US

V. Phone/Fax

Practice location:
  • Phone: 614-252-8180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. VICTORIA BLEM
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 614-329-1721