Provider Demographics
NPI:1851598528
Name:ENTRENA, BLANCA TERESA (DDS)
Entity Type:Individual
Prefix:DR
First Name:BLANCA
Middle Name:TERESA
Last Name:ENTRENA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-4706
Mailing Address - Country:US
Mailing Address - Phone:805-354-8985
Mailing Address - Fax:805-938-1199
Practice Address - Street 1:112 PARK AVE
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-4706
Practice Address - Country:US
Practice Address - Phone:805-354-8985
Practice Address - Fax:805-938-1199
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52602122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice