Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 14716 | MD |
NPI | 1003114000 |
---|---|
Provider Name | Dr. Ashley Wiest Blattner |
First Address | Perry Hall, MD 21128-9828 |
Second Address | Perry Hall, MD 21128-9828 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2011 |
Last Update Date | 01/03/2011 |