MEDICARE: IRVING BLAU DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	9971	MI

General Provider Information

NPI Number	:	1366545527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRVING BLAU DDS

Provider Business Mailing Address
First Line	:	3835 SPANISH OAKS DR
Second Line	:
City	:	W BLOOMFIELD
State	:	MI
Zip	:	48323-1867
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	24415 W WARREN ST
Second Line	:
City	:	DEARBORN HTS
State	:	MI
Zip	:	48127-2223
Country	:	US
Telephone Number	:	313-278-4470
Fax Number	:	313-278-0124

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	07/08/2007

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