Provider Demographics
NPI:1134396674
Name:BLAU, DIANE CAROL (DMD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:CAROL
Last Name:BLAU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:C
Other - Last Name:BLAU-TORRES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:38 MARLTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470
Mailing Address - Country:US
Mailing Address - Phone:973-628-6798
Mailing Address - Fax:973-628-1692
Practice Address - Street 1:38 MARLTON DRIVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470
Practice Address - Country:US
Practice Address - Phone:973-628-6798
Practice Address - Fax:973-628-1692
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01760800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist