Provider Demographics
NPI:1992049647
Name:TURNER, BLAINE IRVING (LD)
Entity type:Individual
Prefix:MR
First Name:BLAINE
Middle Name:IRVING
Last Name:TURNER
Suffix:
Gender:M
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 S 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3110
Mailing Address - Country:US
Mailing Address - Phone:509-452-0331
Mailing Address - Fax:509-469-0230
Practice Address - Street 1:217 S 12TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3110
Practice Address - Country:US
Practice Address - Phone:509-452-0331
Practice Address - Fax:509-469-0230
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN 60318376122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist