Provider Demographics
NPI:1073601548
Name:BLUDAU, ERIC WALTER (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:WALTER
Last Name:BLUDAU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 HARBOR BLVD
Mailing Address - Street 2:STE 210
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2351
Mailing Address - Country:US
Mailing Address - Phone:850-650-5067
Mailing Address - Fax:850-650-5347
Practice Address - Street 1:385 HARBOR BLVD
Practice Address - Street 2:STE 210
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2351
Practice Address - Country:US
Practice Address - Phone:850-650-5067
Practice Address - Fax:850-650-5347
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 159391223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics