Provider Demographics
NPI:1083201248
Name:TEAM PERIO, INC., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:TEAM PERIO, INC., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER/PERIODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BLASINGAME
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:530-241-3302
Mailing Address - Street 1:855 W 7TH ST STE 130
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-2706
Mailing Address - Country:US
Mailing Address - Phone:775-447-1191
Mailing Address - Fax:
Practice Address - Street 1:855 W 7TH ST STE 130
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-2706
Practice Address - Country:US
Practice Address - Phone:775-447-1191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty