| Doctor Name: | EMILY LAINE DORNBLAZER |
| NPI Number: | 1821381880 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DMD |
| License Number: | |
| Business Practice Address: | 2300 Ramsey St Fayetteville, NC - 283013856 |
| Business Phone Number: | 9108227029 |
| Business Fax Number: | |
| Mailing Address: | 6536 Cedar Croft Dr, CHARLOTTE |
| State: | NC |
| Postal Code: | 282700302 |
| Phone Number: | 7046076072 |
| Fax Number: | |
| NPI Enumeration Date: | 05/24/2011 |
| NPI Last Update Date: | 05/24/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |