Organization
BLANCO JAMIS DENTAL GROUP, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JORGE L BLANCO DMD (PRESIDENT)
(305) 262-4604
Entity
Organization
Contact information
Practice address
5701 SW 107TH AVE STE 101, MIAMI, FL 33173-1276
(305) 262-4604
(305) 239-8999
Mailing address
PO BOX 440308, MIAMI, FL 33144-0308
(305) 262-4604
(305) 239-8999
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN 16115
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1609046960
—
FL
Enumeration date
08/15/2012
Last updated
11/17/2021
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