Provider Demographics
NPI:1932346574
Name:DR. NORMAN BLUTH, DR. BARRY BLUTH, PA
Entity Type:Organization
Organization Name:DR. NORMAN BLUTH, DR. BARRY BLUTH, PA
Other - Org Name:BLUTH FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:BLUTH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-792-3800
Mailing Address - Street 1:4175 SW 64TH AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-3459
Mailing Address - Country:US
Mailing Address - Phone:954-792-3800
Mailing Address - Fax:954-792-3377
Practice Address - Street 1:4175 SW 64TH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-3459
Practice Address - Country:US
Practice Address - Phone:954-792-3800
Practice Address - Fax:954-792-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL15109122300000X
FLFL2848122300000X
FLFL126561223G0001X
FLFL169731223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty