MEDICARE: DR. EMILY GRACE BLAND D.M.D.

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	1223G0001X	General Practice Dentistry	50547	CA

General Provider Information

NPI Number	:	1871641597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMILY GRACE BLAND D.M.D.

Provider Business Mailing Address
First Line	:	6080 LAKE MURRAY BLVD
Second Line	:	STE B
City	:	LA MESA
State	:	CA
Zip	:	91942-2571
Country	:	US
Telephone Number	:	619-434-5122
Fax Number	:

Provider Business Practice Location Address
First Line	:	183 S 1ST ST
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92019-4795
Country	:	US
Telephone Number	:	619-328-1335
Fax Number	:

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	02/05/2016

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