Provider Demographics
NPI:1215958855
Name:DR JOHN F BLATTNER & DR. DWIGHT D HEBERER PC
Entity type:Organization
Organization Name:DR JOHN F BLATTNER & DR. DWIGHT D HEBERER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:BLATTNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-939-4042
Mailing Address - Street 1:226 WESTVIEW PLAZA DR.
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-1253
Mailing Address - Country:US
Mailing Address - Phone:618-939-4042
Mailing Address - Fax:618-939-5404
Practice Address - Street 1:226 WESTVIEW PLAZA DR.
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-1253
Practice Address - Country:US
Practice Address - Phone:618-939-4042
Practice Address - Fax:618-939-5404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190165321223G0001X, 332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies