Provider Demographics
NPI:1396856282
Name:DI BLASI, FRANK PATRICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:PATRICK
Last Name:DI BLASI
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 1:690 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2367
Mailing Address - Country:US
Mailing Address - Phone:516-795-5769
Mailing Address - Fax:516-795-8872
Practice Address - Street 1:690 BROADWAY MASSAPEQUA NY 11758 2367
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2367
Practice Address - Country:US
Practice Address - Phone:516-795-5769
Practice Address - Fax:516-795-8872
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030521122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist