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General NPI Number Information
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NPI Number | 1609046960
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Entity Type | Individual
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Provider Name | JORGE L BLANCO D.M.D
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Gender | Male
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Dates
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Enumeration Date | 03/03/2008
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Last Update Date | 03/28/2017
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Provider Practice Location Address
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Address Line | 7801 CORAL WAY SUITE # 100
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City | MIAMI
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State | FL
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Zip | 33155-6538
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Country | US
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Telephone | 305-262-4604
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 440308 SUITE # 100
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City | MIAMI
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State | FL
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Zip | 33144-0308
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Country | US
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Telephone | 786-393-6875
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Fax | 305-697-9785
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN16115
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License Number State | FL
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