Provider Demographics
NPI:1689655599
Name:BLOUNT, MARLA C (DDS)
Entity Type:Individual
Prefix:MS
First Name:MARLA
Middle Name:C
Last Name:BLOUNT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:133 E 58TH ST
Mailing Address - Street 2:SUITE 412
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1236
Mailing Address - Country:US
Mailing Address - Phone:212-751-0555
Mailing Address - Fax:212-751-0556
Practice Address - Street 1:133 E 58TH ST
Practice Address - Street 2:SUITE 412
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1236
Practice Address - Country:US
Practice Address - Phone:212-751-0555
Practice Address - Fax:212-751-0556
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0469581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01742974Medicaid