Provider Demographics
NPI:1417177114
Name:MCLAUGHLIN, BLAINE WRIGHT (DDS)
Entity Type:Individual
Prefix:DR
First Name:BLAINE
Middle Name:WRIGHT
Last Name:MCLAUGHLIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5945 COUNCIL ST NE # B
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5858
Mailing Address - Country:US
Mailing Address - Phone:319-373-5082
Mailing Address - Fax:319-373-7083
Practice Address - Street 1:5945 COUNCIL ST NE # B
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5858
Practice Address - Country:US
Practice Address - Phone:319-373-5082
Practice Address - Fax:319-373-7083
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA77951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1053496760OtherDENTAL TOUCH NPI #
IA0748509Medicaid
IA2130047Medicaid
IA2130047Medicaid