Provider Demographics
NPI:1881795698
Name:BLANCO, MARIEN (DMD)
Entity type:Individual
Prefix:
First Name:MARIEN
Middle Name:
Last Name:BLANCO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2053 AVE PEDRO ALBIZU CAMPOS
Mailing Address - Street 2:SUITE 2 PMB 115
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-5950
Mailing Address - Country:US
Mailing Address - Phone:787-891-3430
Mailing Address - Fax:787-891-6294
Practice Address - Street 1:2053 AVE PEDRO ALBIZU CAMPOS
Practice Address - Street 2:SUITE #1
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5950
Practice Address - Country:US
Practice Address - Phone:787-891-3430
Practice Address - Fax:787-891-6294
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2652122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist