Provider Demographics
NPI:1093198400
Name:ADAM R BLUMER, DMD PC
Entity Type:Organization
Organization Name:ADAM R BLUMER, DMD PC
Other - Org Name:CAROLINA CENTER FOR ORAL AND MAXILLOFACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLUMER
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-574-2011
Mailing Address - Street 1:115 POWELL MILL RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-1531
Mailing Address - Country:US
Mailing Address - Phone:864-574-2011
Mailing Address - Fax:864-576-7377
Practice Address - Street 1:115 POWELL MILL RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-1531
Practice Address - Country:US
Practice Address - Phone:864-574-2011
Practice Address - Fax:864-576-7377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC85001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty