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General NPI Number Information
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NPI Number | 1740859867
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Entity Type | Organization
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Legal Business Name | DANIEL R. BLAZO, DDS, PLLC
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Dates
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Enumeration Date | 06/22/2021
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Last Update Date | 06/22/2021
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Provider Practice Location Address
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Address Line | 22100 OUTER DR
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City | DEARBORN
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State | MI
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Zip | 48124-3932
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Country | US
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Telephone | 313-563-5855
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Fax |
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Provider Business Mailing Address
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Address Line | 22100 OUTER DR
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City | DEARBORN
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State | MI
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Zip | 48124-3932
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Country | US
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Telephone | 313-563-5855
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Fax | 313-563-5865
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANIEL BLAZO
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Credential | DDS
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Telephone | 313-505-0985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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