Provider Demographics
NPI:1619953387
Name:BLUME, CARLEN PALMER (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLEN
Middle Name:PALMER
Last Name:BLUME
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8366 N LOOP 1604 W STE 108
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3533
Mailing Address - Country:US
Mailing Address - Phone:210-614-3334
Mailing Address - Fax:210-614-3331
Practice Address - Street 1:8366 N LOOP 1604 W STE 108
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-3533
Practice Address - Country:US
Practice Address - Phone:210-614-3334
Practice Address - Fax:210-614-3331
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200571223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry