Provider Demographics
NPI:1043382914
Name:BLUM, KAREN ILISE (DDS PA)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ILISE
Last Name:BLUM
Suffix:
Gender:F
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5494 LA SIERRA DRIVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4108
Mailing Address - Country:US
Mailing Address - Phone:214-369-4012
Mailing Address - Fax:214-369-1714
Practice Address - Street 1:5494 LA SIERRA DRIVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4108
Practice Address - Country:US
Practice Address - Phone:214-369-4012
Practice Address - Fax:214-369-1714
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX154761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice