Provider Demographics
NPI:1104270701
Name:BLAND ORAL SURGERY WELLINGTON
Entity type:Organization
Organization Name:BLAND ORAL SURGERY WELLINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:GIANCARLO
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-372-2697
Mailing Address - Street 1:3319 STATE ROAD 7 STE 211
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33449-8092
Mailing Address - Country:US
Mailing Address - Phone:561-395-6464
Mailing Address - Fax:
Practice Address - Street 1:3319 STATE ROAD 7 STE 211
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-8092
Practice Address - Country:US
Practice Address - Phone:561-395-6464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16134261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental