Provider Demographics
NPI:1518196013
Name:JEFFREY D. BLUM, D.D.S., P.A.
Entity Type:Organization
Organization Name:JEFFREY D. BLUM, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-538-4556
Mailing Address - Street 1:4308 ALTON RD
Mailing Address - Street 2:SUITE 850
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-4556
Mailing Address - Country:US
Mailing Address - Phone:305-538-3446
Mailing Address - Fax:305-538-2019
Practice Address - Street 1:4308 ALTON RD
Practice Address - Street 2:SUITE 850
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-4556
Practice Address - Country:US
Practice Address - Phone:305-538-3446
Practice Address - Fax:305-538-2019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN55271223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL85495Medicare PIN