Provider Demographics
NPI:1588384861
Name:BLONG INC.
Entity type:Organization
Organization Name:BLONG INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-373-2612
Mailing Address - Street 1:PO BOX 415
Mailing Address - Street 2:
Mailing Address - City:WASHBURN
Mailing Address - State:WI
Mailing Address - Zip Code:54891-0415
Mailing Address - Country:US
Mailing Address - Phone:715-373-2612
Mailing Address - Fax:715-812-1114
Practice Address - Street 1:16 E BAYFIELD ST
Practice Address - Street 2:
Practice Address - City:WASHBURN
Practice Address - State:WI
Practice Address - Zip Code:54891-4401
Practice Address - Country:US
Practice Address - Phone:715-373-2612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty