Provider Demographics
NPI:1558692392
Name:VANBLARICUM, C SUE (DDS)
Entity Type:Individual
Prefix:DR
First Name:C SUE
Middle Name:
Last Name:VANBLARICUM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37083-1705
Mailing Address - Country:US
Mailing Address - Phone:615-666-6155
Mailing Address - Fax:615-666-7525
Practice Address - Street 1:412 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:TN
Practice Address - Zip Code:37083-1705
Practice Address - Country:US
Practice Address - Phone:615-666-6155
Practice Address - Fax:615-666-7525
Is Sole Proprietor?:No
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS5005122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist