Provider Demographics
NPI:1114087798
Name:CRAIG L BLOGIN DDS PLC
Entity Type:Organization
Organization Name:CRAIG L BLOGIN DDS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:BLOGIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-975-6700
Mailing Address - Street 1:2715 PACKARD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108
Mailing Address - Country:US
Mailing Address - Phone:734-975-6700
Mailing Address - Fax:734-975-9035
Practice Address - Street 1:2715 PACKARD
Practice Address - Street 2:SUITE B
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108
Practice Address - Country:US
Practice Address - Phone:734-975-6700
Practice Address - Fax:734-975-9035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIM013580122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty