Provider Demographics
NPI:1992378152
Name:BLANCO-DENTINO, SYLVANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SYLVANA
Middle Name:
Last Name:BLANCO-DENTINO
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 1:8137 PENDLETON PIKE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-4014
Mailing Address - Country:US
Mailing Address - Phone:317-593-2500
Mailing Address - Fax:
Practice Address - Street 1:8137 PENDLETON PIKE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-4014
Practice Address - Country:US
Practice Address - Phone:317-593-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013670A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist