Provider Demographics
NPI:1235246570
Name:BLAINE, DEBORAH ANNE (DDS)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ANNE
Last Name:BLAINE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N DEARBORN ST
Mailing Address - Street 2:#906
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-6284
Mailing Address - Country:US
Mailing Address - Phone:312-944-4099
Mailing Address - Fax:
Practice Address - Street 1:111 N WABASH AVE
Practice Address - Street 2:#1921
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1903
Practice Address - Country:US
Practice Address - Phone:312-332-4424
Practice Address - Fax:312-332-4423
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice