Provider Demographics
NPI:1821296674
Name:BLICHARZ, CAROLYN REAMER
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:REAMER
Last Name:BLICHARZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 222
Mailing Address - Street 2:62 MAIN STREET
Mailing Address - City:CENTERBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06409-0222
Mailing Address - Country:US
Mailing Address - Phone:860-767-0639
Mailing Address - Fax:
Practice Address - Street 1:62 MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTERBROOK
Practice Address - State:CT
Practice Address - Zip Code:06409-1001
Practice Address - Country:US
Practice Address - Phone:860-767-0639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0098751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice