Provider Demographics
NPI:1811009004
Name:BLANKFORT, JOHN S (DR)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:BLANKFORT
Suffix:
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 MOLINO AVE
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941
Mailing Address - Country:US
Mailing Address - Phone:415-381-0588
Mailing Address - Fax:415-381-3409
Practice Address - Street 1:2515 OCEAN AVE # 1
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132
Practice Address - Country:US
Practice Address - Phone:415-586-2454
Practice Address - Fax:415-381-3409
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA19841122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist