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General NPI Number Information
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NPI Number | 1992378152
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Entity Type | Individual
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Provider Name | SYLVANA BLANCO-DENTINO DDS
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Gender | Female
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Dates
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Enumeration Date | 07/23/2021
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 7020 W NATIONAL AVENUE SUITE 100
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City | WEST ALLIS
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State | WI
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Zip | 53214
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Country | US
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Telephone | 414-475-0588
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Fax | 414-475-1166
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Provider Business Mailing Address
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Address Line | 7020 W NATIONAL AVENUE SUITE 100
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City | WEST ALLIS
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State | WI
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Zip | 53214
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Country | US
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Telephone | 414-475-0588
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Fax | 414-475-1166
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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 | 12013670A
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License Number State | IN
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