Provider Demographics
NPI:1891835161
Name:BLASCHKE, DONALD DAVIS (DDS)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:DAVIS
Last Name:BLASCHKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 E OCEAN AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-7076
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1111 E OCEAN AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7076
Practice Address - Country:US
Practice Address - Phone:805-735-3665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD222011223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD22201Medicare PIN