Provider Demographics
NPI:1063583698
Name:BLUM, SAMUEL (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:BLUM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15720 CRABBS BRANCH WAY
Mailing Address - Street 2:NO 1 C
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20855
Mailing Address - Country:US
Mailing Address - Phone:301-921-9490
Mailing Address - Fax:301-921-0602
Practice Address - Street 1:15720 CRABBS BRANCH WAY
Practice Address - Street 2:NO 1 C
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20855
Practice Address - Country:US
Practice Address - Phone:301-921-9490
Practice Address - Fax:301-921-0602
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD3672122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist