Provider Demographics
NPI:1306010269
Name:CAROL M. BLOSSFELD, D.D.S.
Entity Type:Organization
Organization Name:CAROL M. BLOSSFELD, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLOSSFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-475-9221
Mailing Address - Street 1:3201 E MEMORIAL RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-7104
Mailing Address - Country:US
Mailing Address - Phone:405-475-9221
Mailing Address - Fax:405-475-9224
Practice Address - Street 1:3201 E MEMORIAL RD
Practice Address - Street 2:SUITE A
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-7104
Practice Address - Country:US
Practice Address - Phone:405-475-9221
Practice Address - Fax:405-475-9224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty