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General NPI Number Information
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NPI Number | 1992367809
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Entity Type | Individual
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Provider Name | IAN TIMOTHY BLAHNIK DDS
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Gender | Male
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Dates
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Enumeration Date | 07/01/2019
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Last Update Date | 07/01/2019
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Provider Practice Location Address
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Address Line | 2690 SNELLING AVE N # 250
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City | ROSEVILLE
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State | MN
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Zip | 55113-1700
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Country | US
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Telephone | 651-633-1834
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Fax |
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Provider Business Mailing Address
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Address Line | 4831 W 131 1/2 ST
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City | SAVAGE
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State | MN
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Zip | 55378-2507
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Country | US
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Telephone | 612-910-9477
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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 | D14267
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License Number State | MN
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