Provider Demographics
NPI:1710418678
Name:MARANDA A BLISS PC
Entity Type:Organization
Organization Name:MARANDA A BLISS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARANDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLISS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-435-1295
Mailing Address - Street 1:235 REEDSDALE RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3926
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:66 WINTER ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3333
Practice Address - Country:US
Practice Address - Phone:617-435-1295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-22
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22253261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental