MEDICARE: CARLEN PALMER BLUME DDS, PC

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	:	1720394935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARLEN PALMER BLUME DDS, PC

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	:	DENTIST
Name	:	DR. CARLEN BLUME
Credential	:	DDS
Telephone Number	:	210-614-3334

Provider Enumeration Date	:	08/25/2010
Last Update Date	:	06/19/2019

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