Healthcare Provider Details

I. General information

NPI: 1619267267
Provider Name (Legal Business Name): ADAM RIVERS BLUMER III DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2011
Last Update Date: 09/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 POWELL MILL RD
SPARTANBURG SC
29301-1531
US

IV. Provider business mailing address

115 POWELL MILL RD
SPARTANBURG SC
29301-1531
US

V. Phone/Fax

Practice location:
  • Phone: 864-574-2011
  • Fax:
Mailing address:
  • Phone: 864-574-2011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number8500
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: