Provider Demographics
NPI:1861591398
Name:CHRISTMAN, BLANE (DDS)
Entity type:Individual
Prefix:DR
First Name:BLANE
Middle Name:
Last Name:CHRISTMAN
Suffix:
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 1:425 W PRAIRIE VIEW ROAD
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-3389
Mailing Address - Country:US
Mailing Address - Phone:715-726-1060
Mailing Address - Fax:
Practice Address - Street 1:425 WEST PRAIRIE VIEW ROAD
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-3389
Practice Address - Country:US
Practice Address - Phone:715-726-1060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4080122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33688600Medicaid