Provider Demographics
NPI:1326341124
Name:BL DENTAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:BL DENTAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:BLARDONIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-962-4446
Mailing Address - Street 1:5863 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-4617
Mailing Address - Country:US
Mailing Address - Phone:954-720-2444
Mailing Address - Fax:
Practice Address - Street 1:2600 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1425
Practice Address - Country:US
Practice Address - Phone:305-962-4446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12868305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization