Provider Demographics
NPI:1215502497
Name:BLANCO DENTAL, INC
Entity type:Organization
Organization Name:BLANCO DENTAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALMA
Authorized Official - Middle Name:CAROLINA
Authorized Official - Last Name:BLANCO REYES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-274-0920
Mailing Address - Street 1:316 S AUBURN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-7298
Mailing Address - Country:US
Mailing Address - Phone:530-274-0920
Mailing Address - Fax:530-274-8935
Practice Address - Street 1:316 S AUBURN ST STE 5
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-7298
Practice Address - Country:US
Practice Address - Phone:530-274-0920
Practice Address - Fax:530-274-8935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental