Provider Demographics
NPI:1346242252
Name:BLITZ, NEIL LAWRENCE (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:LAWRENCE
Last Name:BLITZ
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CLARKES VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02835-2803
Mailing Address - Country:US
Mailing Address - Phone:401-556-0625
Mailing Address - Fax:401-423-1416
Practice Address - Street 1:19 CLARKES VILLAGE RD
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:RI
Practice Address - Zip Code:02835-2803
Practice Address - Country:US
Practice Address - Phone:401-556-0625
Practice Address - Fax:401-423-1416
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN128781223X0400X
RI17211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RINB00014Medicaid