Provider Demographics
NPI:1821381880
Name:DORNBLAZER, EMILY LAINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:LAINE
Last Name:DORNBLAZER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 PROFESSIONAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-9388
Mailing Address - Country:US
Mailing Address - Phone:704-607-6072
Mailing Address - Fax:
Practice Address - Street 1:2960 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-9388
Practice Address - Country:US
Practice Address - Phone:704-607-6072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC92071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice