Provider Demographics
NPI:1629150651
Name:BLANCO, EDUARDO CARIDAD (DDS)
Entity Type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:CARIDAD
Last Name:BLANCO
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 1:50 NE 26TH AVE SUITE 403
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-5246
Mailing Address - Country:US
Mailing Address - Phone:954-946-6626
Mailing Address - Fax:954-946-6632
Practice Address - Street 1:50 NE 26TH AVE SUITE 403
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-5246
Practice Address - Country:US
Practice Address - Phone:954-946-6626
Practice Address - Fax:954-946-6632
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0N0013306122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist