Provider Demographics
NPI:1114961471
Name:BLONG, JAMES J (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:BLONG
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 VIEW POINT PL
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-2822
Mailing Address - Country:US
Mailing Address - Phone:414-881-2447
Mailing Address - Fax:
Practice Address - Street 1:3670 S 108TH ST STE 200
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-1237
Practice Address - Country:US
Practice Address - Phone:414-837-5989
Practice Address - Fax:414-837-5992
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI297915122300000X
WI2979-015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist