Provider Demographics
NPI:1346370665
Name:BLAS, ALAN JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JOSEPH
Last Name:BLAS
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:8933 ORIOLE AVE
Mailing Address - Street 2:ALAN J BLAS DDS
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-1853
Mailing Address - Country:US
Mailing Address - Phone:847-657-7997
Mailing Address - Fax:847-657-7987
Practice Address - Street 1:8933 ORIOLE AVE
Practice Address - Street 2:ALAN J BLAS DDS
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-1853
Practice Address - Country:US
Practice Address - Phone:847-657-7997
Practice Address - Fax:847-657-7987
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2013-06-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL0190156511223G0001X
IL0210009901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics