Provider Demographics
NPI:1154569473
Name:BLANCO, FARID (DMD)
Entity type:Individual
Prefix:DR
First Name:FARID
Middle Name:
Last Name:BLANCO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 440308
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-0308
Mailing Address - Country:US
Mailing Address - Phone:786-393-6875
Mailing Address - Fax:305-697-9785
Practice Address - Street 1:4410 W 16TH AVE
Practice Address - Street 2:STE 31
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7835
Practice Address - Country:US
Practice Address - Phone:305-747-7711
Practice Address - Fax:305-697-9785
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17752122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist