Provider Demographics
NPI:1265634182
Name:BLASING, KENNETH HAROLD
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:HAROLD
Last Name:BLASING
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:K.
Other - Middle Name:H
Other - Last Name:BLASING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:412 N 3RD ST
Mailing Address - Street 2:PO 488
Mailing Address - City:ATWATER
Mailing Address - State:MN
Mailing Address - Zip Code:56209-0488
Mailing Address - Country:US
Mailing Address - Phone:320-974-8049
Mailing Address - Fax:
Practice Address - Street 1:445 S MUNSTERMAN ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:MN
Practice Address - Zip Code:56208-2608
Practice Address - Country:US
Practice Address - Phone:320-289-2052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND81731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice