Provider Demographics
NPI:1750567269
Name:GARNER, BLAINE NEVIUS (DMD)
Entity type:Individual
Prefix:DR
First Name:BLAINE
Middle Name:NEVIUS
Last Name:GARNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1942
Mailing Address - Country:US
Mailing Address - Phone:215-860-1550
Mailing Address - Fax:215-860-1550
Practice Address - Street 1:208 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1942
Practice Address - Country:US
Practice Address - Phone:215-860-1550
Practice Address - Fax:215-860-1550
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS20756L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice