Organization
WILLIAM J. BLAUMER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEANA JEANINE BALLARD (OFFICE MANAGER)
(503) 588-6960
Entity
Organization
Contact information
Practice address
1355 EDGEWATER ST NW, SALEM, OR 97304-4077
(503) 588-6960
(503) 365-0056
Mailing address
1355 EDGEWATER ST NW, SALEM, OR 97304-4077
(503) 588-6960
(503) 365-0056
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5026
OR
122300000X
Dentist
5090
OR
122300000X
Dentist
5206
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
54495
UNITED CONCORDIA
OR
01
—
91900
UNITED CONCORDIA
OR
Enumeration date
12/03/2008
Last updated
12/03/2008
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