Provider Demographics
NPI:1134263148
Name:BLATHERS, LENORA (DDS)
Entity type:Individual
Prefix:DR
First Name:LENORA
Middle Name:
Last Name:BLATHERS
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 1:700 7TH STREET SW
Mailing Address - Street 2:SUITE G-2
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024
Mailing Address - Country:US
Mailing Address - Phone:202-554-5100
Mailing Address - Fax:202-554-5101
Practice Address - Street 1:700 7TH STREET SW
Practice Address - Street 2:SUITE G-2
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024
Practice Address - Country:US
Practice Address - Phone:202-554-5100
Practice Address - Fax:202-554-5101
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD127811223S0112X
DCDEN10001051223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC053860400Medicaid
MD21928-3Medicaid
MD01620252OtherUNITED CONCORDIA