Provider Demographics
NPI:1619181138
Name:BLANCO- SPAETH, LIGIA I (DDS)
Entity Type:Individual
Prefix:MRS
First Name:LIGIA
Middle Name:I
Last Name:BLANCO- SPAETH
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 1:343 E ALVARADO ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-1757
Mailing Address - Country:US
Mailing Address - Phone:951-712-9273
Mailing Address - Fax:626-333-4666
Practice Address - Street 1:343 E ALVARADO ST
Practice Address - Street 2:SUITE B
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-1757
Practice Address - Country:US
Practice Address - Phone:951-712-9273
Practice Address - Fax:626-333-4666
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0349321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice