Provider Demographics
NPI:1720394935
Name:CARLEN PALMER BLUME DDS, PC
Entity Type:Organization
Organization Name:CARLEN PALMER BLUME DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUME
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-614-3334
Mailing Address - Street 1:8366 N LOOP 1604 W STE 108
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3533
Mailing Address - Country:US
Mailing Address - Phone:210-614-3334
Mailing Address - Fax:210-614-3331
Practice Address - Street 1:8366 N LOOP 1604 W STE 108
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-3533
Practice Address - Country:US
Practice Address - Phone:210-614-3334
Practice Address - Fax:210-614-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-25
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200571223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty