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General NPI Number Information
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NPI Number | 1275657843
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Entity Type | Individual
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Provider Name | FREDRIC A BLONSTEIN DDS
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Gender | Male
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 103 S CHURCH ST
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City | NEW CARLISLE
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State | OH
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Zip | 45344-1903
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Country | US
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Telephone | 937-845-0038
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Fax | 937-845-8724
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Provider Business Mailing Address
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Address Line | 7173 HUNTERS CRK
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City | CENTERVILLE FINANCE
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State | OH
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Zip | 45459-3468
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30012838
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License Number State | OH
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