Provider Demographics
NPI:1598740912
Name:BLODGETT, ROBERT FRANKLIN JR (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FRANKLIN
Last Name:BLODGETT
Suffix:JR
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 80 BOX 18128
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96367 8100
Mailing Address - Country:US
Mailing Address - Phone:611-733-1823
Mailing Address - Fax:
Practice Address - Street 1:18TH DENTAL SQUADRON
Practice Address - Street 2:UNIT 5270
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96368 5270
Practice Address - Country:US
Practice Address - Phone:611-730-4882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 90951223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics