Provider Demographics
NPI:1023198611
Name:BLAESS, IRENE K (DDS)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:K
Last Name:BLAESS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5999 DE ZAVALA RD
Mailing Address - Street 2:#122
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249
Mailing Address - Country:US
Mailing Address - Phone:210-691-1333
Mailing Address - Fax:210-561-2599
Practice Address - Street 1:5999 DE ZAVALA RD
Practice Address - Street 2:#122
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249
Practice Address - Country:US
Practice Address - Phone:210-691-1333
Practice Address - Fax:210-561-2599
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX190061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice