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General NPI Number Information
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NPI Number | 1992155568
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Entity Type | Individual
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Provider Name | JEFF BLOMSTEDT DDS
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Gender | Male
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Dates
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Enumeration Date | 06/15/2016
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Last Update Date | 07/15/2016
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Provider Practice Location Address
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Address Line | 1510 E 20TH ST SUITE B
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City | FARMINGTON
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State | NM
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Zip | 87401-9033
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Country | US
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Telephone | 505-327-6151
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Fax |
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Provider Business Mailing Address
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Address Line | 4015 ABBEY RD
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City | FARMINGTON
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State | NM
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Zip | 87402-2901
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Country | US
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Telephone | 308-737-0684
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Fax |
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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 | DD4520
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License Number State | NM
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