Provider Demographics
NPI:1952947780
Name:N BLANCO DDS DENTAL CORPORATION INC
Entity Type:Organization
Organization Name:N BLANCO DDS DENTAL CORPORATION INC
Other - Org Name:N BLANCO DDS DENTAL CORPORATION INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NUBIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-919-2315
Mailing Address - Street 1:1431 N HACIENDA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-1133
Mailing Address - Country:US
Mailing Address - Phone:626-919-2315
Mailing Address - Fax:626-919-5892
Practice Address - Street 1:1431 N HACIENDA BLVD
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-1133
Practice Address - Country:US
Practice Address - Phone:626-919-2315
Practice Address - Fax:626-919-5892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-27
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental