Provider Demographics
NPI:1487847703
Name:BLASER, KIMBERLY (DDS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BLASER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5016 W HOBBY HORSE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-5452
Mailing Address - Country:US
Mailing Address - Phone:623-266-0243
Mailing Address - Fax:
Practice Address - Street 1:3618 W ANTHEM WAY
Practice Address - Street 2:SUITE #D-104
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-0419
Practice Address - Country:US
Practice Address - Phone:623-935-9873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ56101223P0221X
IDD-34951223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry