Provider Demographics
NPI:1447258165
Name:BLAUMER, WILLIAM J (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:BLAUMER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 EDGEWATER ST NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-4077
Mailing Address - Country:US
Mailing Address - Phone:503-588-6960
Mailing Address - Fax:503-365-0056
Practice Address - Street 1:1355 EDGEWATER ST NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-4077
Practice Address - Country:US
Practice Address - Phone:503-588-6960
Practice Address - Fax:503-365-0056
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR50261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR031836Medicaid