Provider Demographics
NPI:1558570341
Name:BLOGIN, CRAIG LEONARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:LEONARD
Last Name:BLOGIN
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 1:2715 PACKARD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-3336
Mailing Address - Country:US
Mailing Address - Phone:734-975-6700
Mailing Address - Fax:734-975-9035
Practice Address - Street 1:2715 PACKARD ST
Practice Address - Street 2:SUITE B
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-3336
Practice Address - Country:US
Practice Address - Phone:734-975-6700
Practice Address - Fax:734-975-9035
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0135801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID13580OtherBCBS