Healthcare Provider Details

I. General information

NPI: 1780841783
Provider Name (Legal Business Name): RICHARD M BLASER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MERRY DELL DR
CHURCHVILLE PA
18966-1135
US

IV. Provider business mailing address

25 MERRY DELL DR
CHURCHVILLE PA
18966-1135
US

V. Phone/Fax

Practice location:
  • Phone: 215-355-6411
  • Fax:
Mailing address:
  • Phone: 215-355-6411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS024310L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: