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General NPI Number Information
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NPI Number | 1821907783
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Entity Type | Organization
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Legal Business Name | BLAINE LAKES DENTAL, P.L.L.C.
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Dates
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Enumeration Date | 09/04/2026
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Last Update Date | 09/04/2026
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Provider Practice Location Address
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Address Line | 10705 TOWN SQUARE DR NE STE 200
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City | BLAINE
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State | MN
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Zip | 55449-8187
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Country | US
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Telephone | 763-757-1535
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Fax |
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Provider Business Mailing Address
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Address Line | 10705 TOWN SQUARE DR NE STE 200
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City | BLAINE
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State | MN
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Zip | 55449-8187
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Country | US
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Telephone | 763-757-1535
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. FIRDAVS Z ABZHABAROV
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Credential | DDS
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Telephone | 612-563-9313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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