Provider Demographics
NPI:1265578413
Name:BLUHM, DORSCH AND VANDERVORT, PC
Entity type:Organization
Organization Name:BLUHM, DORSCH AND VANDERVORT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BLUHM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-729-8700
Mailing Address - Street 1:44340 PREMIER PLZ
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5073
Mailing Address - Country:US
Mailing Address - Phone:703-729-8700
Mailing Address - Fax:703-729-5300
Practice Address - Street 1:44340 PREMIER PLZ
Practice Address - Street 2:SUITE 100
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5025
Practice Address - Country:US
Practice Address - Phone:703-729-8700
Practice Address - Fax:703-729-5300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007764174400000X
1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA450039OtherBCBS
VA067698OtherBCBS
VA066607OtherBCBS
VA450038OtherBCBS
VA067698OtherBCBS
VA190000503Medicare ID - Type Unspecified
VA450039OtherBCBS