Provider Demographics
NPI:1386300689
Name:BLUTH DENTISTRY LLC
Entity type:Organization
Organization Name:BLUTH DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-223-4844
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:ABBOTSFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54405-0147
Mailing Address - Country:US
Mailing Address - Phone:715-223-4844
Mailing Address - Fax:715-223-6957
Practice Address - Street 1:202 E BIRCH ST
Practice Address - Street 2:
Practice Address - City:ABBOTSFORD
Practice Address - State:WI
Practice Address - Zip Code:54405-9439
Practice Address - Country:US
Practice Address - Phone:715-223-4844
Practice Address - Fax:715-223-6957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty