Provider Demographics
NPI:1114153343
Name:BLOMER, KATLIN (DMD)
Entity Type:Individual
Prefix:
First Name:KATLIN
Middle Name:
Last Name:BLOMER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KATLIN
Other - Middle Name:
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3870 PAXTON AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-2366
Mailing Address - Country:US
Mailing Address - Phone:513-979-6998
Mailing Address - Fax:513-979-6990
Practice Address - Street 1:3870 PAXTON AVE
Practice Address - Street 2:SUITE G
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-2366
Practice Address - Country:US
Practice Address - Phone:513-979-6998
Practice Address - Fax:513-979-6990
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0233901223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry