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General NPI Number Information
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NPI Number | 1417044710
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Entity Type | Individual
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Provider Name | JEFFREY BLANK DDS
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Gender | Male
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 22 NORTH PRINCE ST
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City | POTTSTOWN
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State | PA
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Zip | 19464
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Country | US
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Telephone | 610-327-2937
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Fax | 610-327-8243
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Provider Business Mailing Address
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Address Line | 75 FOXCRAFT LANE
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City | PHOENIXVILLE
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State | PA
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Zip | 19460
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Country | US
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Telephone | 610-933-6411
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Fax | 610-327-8243
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DS17608L
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License Number State | PA
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