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General NPI Number Information
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NPI Number | 1386300689
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Entity Type | Organization
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Legal Business Name | BLUTH DENTISTRY LLC
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Dates
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Enumeration Date | 11/10/2021
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Last Update Date | 11/10/2021
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Provider Practice Location Address
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Address Line | 202 E BIRCH ST
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City | ABBOTSFORD
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State | WI
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Zip | 54405-9439
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Country | US
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Telephone | 715-223-4844
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Fax | 715-223-6957
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Provider Business Mailing Address
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Address Line | PO BOX 147
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City | ABBOTSFORD
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State | WI
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Zip | 54405-0147
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Country | US
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Telephone | 715-223-4844
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Fax | 715-223-6957
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW BLUTH
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Credential | DDS
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Telephone | 715-223-4844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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