Provider Demographics
NPI:1689723991
Name:BLANC, KATHLEEN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:D
Last Name:BLANC
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 1:6750 BIDDULPH RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BROOKLYN
Mailing Address - State:OH
Mailing Address - Zip Code:44144-3307
Mailing Address - Country:US
Mailing Address - Phone:216-485-1211
Mailing Address - Fax:
Practice Address - Street 1:6750 BIDDULPH RD
Practice Address - Street 2:SUITE 105
Practice Address - City:BROOKLYN
Practice Address - State:OH
Practice Address - Zip Code:44144-3307
Practice Address - Country:US
Practice Address - Phone:216-485-1211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300206501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice