Provider Demographics
NPI:1437242849
Name:SMID, BLANKA (DDS)
Entity Type:Individual
Prefix:DR
First Name:BLANKA
Middle Name:
Last Name:SMID
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 BALTIMORE BLVD
Mailing Address - Street 2:P.O.BOX816
Mailing Address - City:FINKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21048-1648
Mailing Address - Country:US
Mailing Address - Phone:410-876-2774
Mailing Address - Fax:410-751-2907
Practice Address - Street 1:2222 BALTIMORE BLVD
Practice Address - Street 2:
Practice Address - City:FINKSBURG
Practice Address - State:MD
Practice Address - Zip Code:21048-1648
Practice Address - Country:US
Practice Address - Phone:410-876-2774
Practice Address - Fax:410-751-2907
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD112691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice