Provider Demographics
NPI:1013013614
Name:GOLDBLATT, STUART LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:LEE
Last Name:GOLDBLATT
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 1:2310 BIRCHWOOD CT N
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-6680
Mailing Address - Country:US
Mailing Address - Phone:847-634-1505
Mailing Address - Fax:773-594-9996
Practice Address - Street 1:6554 W HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-2161
Practice Address - Country:US
Practice Address - Phone:773-736-5151
Practice Address - Fax:773-594-9997
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A13824122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist