Provider Demographics
NPI:1164494332
Name:BLUNDELL, ROBERT EUGENE JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EUGENE
Last Name:BLUNDELL
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17617 W 70TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66217-9437
Mailing Address - Country:US
Mailing Address - Phone:913-631-3796
Mailing Address - Fax:
Practice Address - Street 1:650 E 25TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2716
Practice Address - Country:US
Practice Address - Phone:816-235-6196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO132361223E0200X
KS61001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics