Provider Demographics
NPI:1154765337
Name:L B DENTAL P. C.
Entity type:Organization
Organization Name:L B DENTAL P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:914-935-0588
Mailing Address - Street 1:220 WESTCHESTER AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-4557
Mailing Address - Country:US
Mailing Address - Phone:914-935-0588
Mailing Address - Fax:914-935-0445
Practice Address - Street 1:220 WESTCHESTER AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-4557
Practice Address - Country:US
Practice Address - Phone:914-935-0588
Practice Address - Fax:914-935-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental