Provider Demographics
NPI:1821040239
Name:BLUMENTHAL, NEIL MARK (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:MARK
Last Name:BLUMENTHAL
Suffix:
Gender:M
Credentials:DDS, MS
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Other - Credentials:
Mailing Address - Street 1:17926 HALSTED ST
Mailing Address - Street 2:SUITE 3NW
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2029
Mailing Address - Country:US
Mailing Address - Phone:708-798-0714
Mailing Address - Fax:708-798-4487
Practice Address - Street 1:17926 HALSTED ST
Practice Address - Street 2:SUITE 3NW
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2029
Practice Address - Country:US
Practice Address - Phone:708-798-0714
Practice Address - Fax:708-798-4487
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics