Provider Demographics
NPI:1073911400
Name:BLATT FAMILY DENTAL, P.C.
Entity Type:Organization
Organization Name:BLATT FAMILY DENTAL, P.C.
Other - Org Name:KINGSTON FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BLATT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-439-0779
Mailing Address - Street 1:17 LEVESQUE DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ELIOT
Mailing Address - State:ME
Mailing Address - Zip Code:03903-2064
Mailing Address - Country:US
Mailing Address - Phone:207-439-0779
Mailing Address - Fax:207-439-0883
Practice Address - Street 1:17 LEVESQUE DR
Practice Address - Street 2:SUITE 3
Practice Address - City:ELIOT
Practice Address - State:ME
Practice Address - Zip Code:03903-2064
Practice Address - Country:US
Practice Address - Phone:207-439-0779
Practice Address - Fax:207-439-0883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME42151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty