Provider Demographics
NPI:1164564316
Name:ROBERT E. BLEW
Entity Type:Organization
Organization Name:ROBERT E. BLEW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:BLEW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:309-797-4336
Mailing Address - Street 1:604 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6174
Mailing Address - Country:US
Mailing Address - Phone:309-797-4336
Mailing Address - Fax:
Practice Address - Street 1:604 35TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6174
Practice Address - Country:US
Practice Address - Phone:309-797-4336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A14799261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental