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General NPI Number Information
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NPI Number | 1851500292
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Entity Type | Organization
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Legal Business Name | ALLEN J. BLASS, D.D.S.
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4920 ROSWELL RD NE SUITE 13A
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City | ATLANTA
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State | GA
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Zip | 30342-2601
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Country | US
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Telephone | 404-236-7222
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Fax | 404-250-9143
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Provider Business Mailing Address
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Address Line | 4920 ROSWELL RD NE SUITE 13A
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City | ATLANTA
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State | GA
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Zip | 30342-2601
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Country | US
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Telephone | 404-236-7222
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Fax | 404-250-9143
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. CYNTHIA LAWLESS
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Credential |
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Telephone | 404-236-7222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 008304
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 008787
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 006716
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License Number State | GA
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