Provider Demographics
NPI:1548383169
Name:BLEW FAMILY DENTISTRY, P.C.
Entity Type:Organization
Organization Name:BLEW FAMILY DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:BLEW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:309-797-4336
Mailing Address - Street 1:604 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6174
Mailing Address - Country:US
Mailing Address - Phone:309-797-4336
Mailing Address - Fax:
Practice Address - Street 1:604 35TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6174
Practice Address - Country:US
Practice Address - Phone:309-797-4336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019024739122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty