Provider Demographics
NPI:1013587146
Name:BLAISE C. ECKERT, DDS
Entity Type:Organization
Organization Name:BLAISE C. ECKERT, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORAL & MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAISE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ECKERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:617-484-5266
Mailing Address - Street 1:68 LEONARD ST STE 301
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-2574
Mailing Address - Country:US
Mailing Address - Phone:617-484-5266
Mailing Address - Fax:617-484-2739
Practice Address - Street 1:68 LEONARD ST STE 301
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-2574
Practice Address - Country:US
Practice Address - Phone:617-484-5266
Practice Address - Fax:617-484-2739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty