=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952252256
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLANCO FAMILY DENTAL INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2026
-----------------------------------------------------
Last Update Date | 02/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23451 MADISON ST. SUITE 180
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90505-4760
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-378-8494
-----------------------------------------------------
Fax | 310-791-0572
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23451 MADISON ST. SUITE 180
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90505-4760
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-378-8494
-----------------------------------------------------
Fax | 310-791-0572
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DOCTOR
-----------------------------------------------------
Name | CHRISTIAN MARTIN BLANCO
-----------------------------------------------------
Credential | D.M.D
-----------------------------------------------------
Telephone | 310-378-8494
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------