Provider Demographics
NPI:1770212334
Name:BLUM, BRIANNA LEIGH (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIANNA
Middle Name:LEIGH
Last Name:BLUM
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 1:948 BONAPARTE LANDING CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-6745
Mailing Address - Country:US
Mailing Address - Phone:772-473-9727
Mailing Address - Fax:
Practice Address - Street 1:14006 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-1597
Practice Address - Country:US
Practice Address - Phone:904-301-4250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN269571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice