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General NPI Number Information
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NPI Number | 1356516454
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Entity Type | Individual
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Provider Name | JORGE RAUL BLANCO D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 7700 SW 57TH AVE
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-5415
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Country | US
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Telephone | 305-670-0352
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Fax | 305-670-3352
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Provider Business Mailing Address
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Address Line | 7700 S.W. 57TH AVENUE
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-5415
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Country | US
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Telephone | 305-670-0352
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Fax | 305-670-3352
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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 | 11775
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License Number State | FL
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