MEDICARE: DR. BRICE BLAHNIK DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D14445	MN
2	122300000X	Dentist	D12086	OR

General Provider Information

NPI Number	:	1225643307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRICE BLAHNIK DDS

Provider Business Mailing Address
First Line	:	721 WAVERLY DR SE
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97322-5080
Country	:	US
Telephone Number	:	541-928-8434
Fax Number	:

Provider Business Practice Location Address
First Line	:	721 WAVERLY DR SE
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97322-5080
Country	:	US
Telephone Number	:	541-928-8434
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2020
Last Update Date	:	12/03/2024

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Directions to “ DR. BRICE BLAHNIK DDS” Practice Location

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