Provider Demographics
NPI:1346443355
Name:BARTON R. BLUMBERG, D.M.D., P.A.
Entity Type:Organization
Organization Name:BARTON R. BLUMBERG, D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARTON
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLUMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-430-2100
Mailing Address - Street 1:1503 BUENOS AIRES BLVD.
Mailing Address - Street 2:STE. 190
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159
Mailing Address - Country:US
Mailing Address - Phone:352-430-2100
Mailing Address - Fax:352-430-1297
Practice Address - Street 1:1503 BUENOS AIRES BLVD.
Practice Address - Street 2:STE. 190
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159
Practice Address - Country:US
Practice Address - Phone:352-430-2100
Practice Address - Fax:352-430-1297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 9030261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery