Provider Demographics
NPI:1528585775
Name:GEOFFREY W BLATTER, DMD, PC
Entity Type:Organization
Organization Name:GEOFFREY W BLATTER, DMD, PC
Other - Org Name:LEBANON FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:BLATTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-600-0280
Mailing Address - Street 1:1305 SE 13TH PL
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-4352
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 E OAK ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-4135
Practice Address - Country:US
Practice Address - Phone:541-451-1176
Practice Address - Fax:541-451-1424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental