Provider Demographics
NPI:1700878204
Name:BLANCO, AMUERFINA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMUERFINA
Middle Name:M
Last Name:BLANCO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27092 HESPERIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-3541
Mailing Address - Country:US
Mailing Address - Phone:510-782-1010
Mailing Address - Fax:510-782-1092
Practice Address - Street 1:27092 HESPERIAN BLVD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-3541
Practice Address - Country:US
Practice Address - Phone:510-782-1010
Practice Address - Fax:510-782-1092
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA415891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice