Provider Demographics
NPI:1336261502
Name:BLANEY, PATRICK CHARLES I (DDS)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:CHARLES
Last Name:BLANEY
Suffix:I
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 N CASS AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1601
Mailing Address - Country:US
Mailing Address - Phone:630-969-1975
Mailing Address - Fax:630-969-1973
Practice Address - Street 1:19 N CASS AVE
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1601
Practice Address - Country:US
Practice Address - Phone:630-969-1975
Practice Address - Fax:630-969-1973
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19017327122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist