Provider Demographics
NPI:1730239674
Name:BLANKSTEIN, GARY (DDS)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:BLANKSTEIN
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 1:8930 S SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3606
Mailing Address - Country:US
Mailing Address - Phone:310-645-6033
Mailing Address - Fax:310-410-0990
Practice Address - Street 1:8930 S SEPULVEDA BLVD
Practice Address - Street 2:SUITE 118
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3606
Practice Address - Country:US
Practice Address - Phone:310-645-6033
Practice Address - Fax:310-410-0990
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30337122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist