MEDICARE: BLAIN DENTAL SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	1223E0200X	Endodontics
2	1223P0300X	Periodontics
3	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
4	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
5	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1699591743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLAIN DENTAL SERVICES

Provider Business Mailing Address
First Line	:	15535 SW 120TH ST STE 5
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33196-6216
Country	:	US
Telephone Number	:	786-929-0099
Fax Number	:

Provider Business Practice Location Address
First Line	:	15535 SW 120TH ST STE 5
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33196-6216
Country	:	US
Telephone Number	:	786-929-0099
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. ANA M BLAIN ABDALA
Credential	:	DMD
Telephone Number	:	786-650-4099

Provider Enumeration Date	:	11/22/2024
Last Update Date	:	11/22/2024

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