Provider Demographics
NPI:1144351826
Name:BLATT, WILLIAM H JR (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:H
Last Name:BLATT
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:OH
Mailing Address - Zip Code:44041-1229
Mailing Address - Country:US
Mailing Address - Phone:440-466-7077
Mailing Address - Fax:440-466-2260
Practice Address - Street 1:460 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041-1229
Practice Address - Country:US
Practice Address - Phone:440-466-7077
Practice Address - Fax:440-466-2260
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0201731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice