MEDICARE: MR. ERIC S. A. BLAMIRES D.M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	5935496-9922	UT
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	10418	CO

General Provider Information

NPI Number	:	1982872461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC S. A. BLAMIRES D.M.D

Provider Business Mailing Address
First Line	:	135 BECKWITH DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-5931
Country	:	US
Telephone Number	:	719-660-2791
Fax Number	:	719-392-1589

Provider Business Practice Location Address
First Line	:	135 BECKWITH DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-5931
Country	:	US
Telephone Number	:	719-660-2791
Fax Number	:	719-392-1589

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2008
Last Update Date	:	01/17/2012

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