Provider Demographics
NPI:1780304204
Name:BLAIN ABDALA, ANA MARGARITA
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:MARGARITA
Last Name:BLAIN ABDALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15080 SW 180TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-6273
Mailing Address - Country:US
Mailing Address - Phone:786-650-4099
Mailing Address - Fax:
Practice Address - Street 1:340 SE 3RD ST APT 2606
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-1745
Practice Address - Country:US
Practice Address - Phone:786-650-4099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN275051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice