Provider Demographics
NPI:1376682120
Name:DENTAL OFFICE OF IRENE K BLAESS
Entity Type:Organization
Organization Name:DENTAL OFFICE OF IRENE K BLAESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:K
Authorized Official - Last Name:BLAESS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-691-1333
Mailing Address - Street 1:5999 DE ZAVALA RD
Mailing Address - Street 2:STE #122
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249
Mailing Address - Country:US
Mailing Address - Phone:210-691-1333
Mailing Address - Fax:210-561-2599
Practice Address - Street 1:5999 DE ZAVALA RD
Practice Address - Street 2:STE #122
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249
Practice Address - Country:US
Practice Address - Phone:210-691-1333
Practice Address - Fax:210-561-2599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19006122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty