Provider Demographics
NPI:1518905579
Name:BLUM, JEFFREY DENNIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DENNIS
Last Name:BLUM
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 1:4308 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:305-538-4556
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:305-538-4556
Practice Address - Fax:305-538-2019
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL55271223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT85699Medicare UPIN
FL85495Medicare ID - Type UnspecifiedMEDICARE