Provider Demographics
NPI:1053159715
Name:HIDALGO, BLAIR HUMBELINA (RDH)
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:HUMBELINA
Last Name:HIDALGO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NAVAL MEDICAL CENTER
Mailing Address - Street 2:100 BREWSTER BL VD
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28547
Mailing Address - Country:US
Mailing Address - Phone:910-451-2208
Mailing Address - Fax:
Practice Address - Street 1:NAVAL MEDICAL CENTER
Practice Address - Street 2:100 BREWSTER BL VD
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547
Practice Address - Country:US
Practice Address - Phone:910-451-2208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13441124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist