Provider Demographics
NPI:1992378152
Name:BLANCO-DENTINO, SYLVANA (DDS)
Entity type:Individual
Prefix:DR
First Name:SYLVANA
Middle Name:
Last Name:BLANCO-DENTINO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7020 W NATIONAL AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214
Mailing Address - Country:US
Mailing Address - Phone:414-475-0588
Mailing Address - Fax:414-475-1166
Practice Address - Street 1:7020 W NATIONAL AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214
Practice Address - Country:US
Practice Address - Phone:414-475-0588
Practice Address - Fax:414-475-1166
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013670A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist