Provider Demographics
NPI:1124194816
Name:BLAUZVERN, PETER M (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:M
Last Name:BLAUZVERN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2025
Mailing Address - Country:US
Mailing Address - Phone:516-681-5800
Mailing Address - Fax:
Practice Address - Street 1:366 N BROADWAY
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2025
Practice Address - Country:US
Practice Address - Phone:516-681-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY376881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice