Provider Demographics
NPI:1548463763
Name:BLUMBERG, BARTON R (DMD)
Entity type:Individual
Prefix:DR
First Name:BARTON
Middle Name:R
Last Name:BLUMBERG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1503 BUENOS AIRES BLVD.
Mailing Address - Street 2:STE. 190
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159
Mailing Address - Country:US
Mailing Address - Phone:352-430-2100
Mailing Address - Fax:352-430-1297
Practice Address - Street 1:1503 BUENOS AIRES BLVD.
Practice Address - Street 2:STE. 190
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159
Practice Address - Country:US
Practice Address - Phone:352-430-2100
Practice Address - Fax:352-430-1297
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLDN 90301223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery