Provider Demographics
NPI:1740353028
Name:BLANDING, KIMBERLY (DDS)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BLANDING
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 1:411 BILLINGSLEY RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1046
Mailing Address - Country:US
Mailing Address - Phone:704-938-4211
Mailing Address - Fax:
Practice Address - Street 1:411 BILLINGSLEY RD
Practice Address - Street 2:SUITE 106
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1046
Practice Address - Country:US
Practice Address - Phone:704-938-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7392122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903219Medicaid