MEDICARE: DR. CARLEN PALMER BLUME 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	1223P0221X	Pediatric Dentistry	20057	TX

General Provider Information

NPI Number	:	1619953387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLEN PALMER BLUME DDS

Provider Business Mailing Address
First Line	:	8366 N LOOP 1604 W STE 108
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-3533
Country	:	US
Telephone Number	:	210-614-3334
Fax Number	:	210-614-3331

Provider Business Practice Location Address
First Line	:	8366 N LOOP 1604 W STE 108
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-3533
Country	:	US
Telephone Number	:	210-614-3334
Fax Number	:	210-614-3331

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

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	09/18/2018

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