Provider Demographics
NPI:1801009337
Name:BLANEY, RODNEY A (DMD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:A
Last Name:BLANEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8544 S STONY ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-2248
Mailing Address - Country:US
Mailing Address - Phone:773-221-0800
Mailing Address - Fax:773-221-0868
Practice Address - Street 1:8544 S STONY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-2248
Practice Address - Country:US
Practice Address - Phone:773-221-0800
Practice Address - Fax:773-221-0868
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0203251223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice