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General NPI Number Information
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NPI Number | 1487847703
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Entity Type | Individual
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Provider Name | KIMBERLY BLASER DDS
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Gender | Female
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Dates
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Enumeration Date | 08/20/2007
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Last Update Date | 08/20/2007
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Provider Practice Location Address
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Address Line | 3618 W ANTHEM WAY SUITE #D-104
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City | ANTHEM
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State | AZ
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Zip | 85086-0419
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Country | US
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Telephone | 623-935-9873
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Fax |
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Provider Business Mailing Address
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Address Line | 5016 W HOBBY HORSE DR
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City | PHOENIX
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State | AZ
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Zip | 85083-5452
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Country | US
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Telephone | 623-266-0243
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 5610
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D-3495
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License Number State | ID
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