Provider Demographics
NPI:1679674972
Name:BLUM, DAMIAN D (DMD, PA)
Entity Type:Individual
Prefix:DR
First Name:DAMIAN
Middle Name:D
Last Name:BLUM
Suffix:
Gender:M
Credentials:DMD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10132 BALTIMORE NATIONAL PIKE
Mailing Address - Street 2:SUITE #C
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-3607
Mailing Address - Country:US
Mailing Address - Phone:410-465-3224
Mailing Address - Fax:410-465-4760
Practice Address - Street 1:10132 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:SUITE #C
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-3607
Practice Address - Country:US
Practice Address - Phone:410-465-3224
Practice Address - Fax:410-465-4760
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD86451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice