Provider Demographics
NPI:1205000213
Name:JOHN G BLAZIC DDS INC
Entity Type:Organization
Organization Name:JOHN G BLAZIC DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARCUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-839-4604
Mailing Address - Street 1:1655 HAWTHORNE DR
Mailing Address - Street 2:SUITE F & G
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-1895
Mailing Address - Country:US
Mailing Address - Phone:317-839-4604
Mailing Address - Fax:317-837-2436
Practice Address - Street 1:1655 HAWTHORNE DR
Practice Address - Street 2:SUITE F & G
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-1895
Practice Address - Country:US
Practice Address - Phone:317-839-4604
Practice Address - Fax:317-837-2436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty