Provider Demographics
NPI:1053199000
Name:BLENDE DENTAL CORPORATION
Entity type:Organization
Organization Name:BLENDE DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-497-7319
Mailing Address - Street 1:390 LAUREL ST STE 310
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1953
Mailing Address - Country:US
Mailing Address - Phone:415-563-4261
Mailing Address - Fax:
Practice Address - Street 1:390 LAUREL ST STE 310
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1953
Practice Address - Country:US
Practice Address - Phone:415-563-4261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty