Provider Demographics
NPI:1316476005
Name:BLOINK IV, WILLIAM AUGUST
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:AUGUST
Last Name:BLOINK IV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 S KOKE MILL RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-8194
Mailing Address - Country:US
Mailing Address - Phone:217-793-8899
Mailing Address - Fax:217-793-9662
Practice Address - Street 1:2701 S KOKE MILL RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-8194
Practice Address - Country:US
Practice Address - Phone:217-793-8899
Practice Address - Fax:217-793-9662
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019031107122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist