Provider Demographics
NPI:1003547829
Name:BLUMENTHAL, MAX HARLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAX
Middle Name:HARLEY
Last Name:BLUMENTHAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SIBLEY AVE APT 208
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2347
Mailing Address - Country:US
Mailing Address - Phone:610-761-7251
Mailing Address - Fax:
Practice Address - Street 1:6 ORIOLE AVE
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-4515
Practice Address - Country:US
Practice Address - Phone:610-679-6109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0436951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice